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Home My WebLink AboutMILLPLACE ESTATES LT 2Onsite File lift 411M 4ft A WED 0 ROL Ar In A and LT 16B On -Site Water and Wastewater Section - (907) 343-7904 Page 1 of 3 ®IWASTEWATER INSPECTION REPORT Permit Number: OS 201188 PID Number: 015 -112 - Dwelling: On Single Family (SF) n with ADU F1 Duplex (D) n Two Single Family Project: n New On Upgrade Name Z Paul & Therisa Kvernplassen A ORPTION FIELD Site Address n De Trench n Wide Trench n Bed E] Mound 10487 Elmore Rd. Anchorage, AK Other her Phone Number of Bedrooms Soil RatingTotal depth from original grade 229-8800 1 3, Existing/SF J Ft. LEGAL DESCRIPTION Depth to pipe invert from original de Gravel depth beneath pipe Subdivision Block Lot Millplace Estates* 2 Ft. Fill added above original grade I Gr�A�gth Township Range Section Ft. Ft. Gravel width Beds: Number of Lines Dist e between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between ches From Tank Field Tank Line Ft2 Well >100' N/A N/A N/A >25s TANK N Septic E] S.T.E.P. 1771 Holding El Other Manufacturer Capacity Surface Water >1 00' N/A N/A N/A Greer 1000Gal. Material Number of compartments LotLot Line >5' N/A N/A N/A NA Plastic 2 Foundation> 10' N/A N/ / TATION Manufacturer Capacity Remarks * Formerly T1N R3 ec15 L1B Gal. Alarm location Electric i ailed by PIPE MATERIAL House to tank D3034 Tank to D3034 Installer A+ Home Services - drainfield - Drainfield Existing CO/MT D3034 Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspection 8/17/20 nd Location and description dates: 2 3rd 4th Bottom of siding on west side of house ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp 7*Z Nz� OFA Aw? Conditional Approval: Date low wo, 49 J enja0R,1ller Septic System (A B k F0 Approved i,Date I ## t C1E/26592 Note: this approval does not include well permit requirements. (Rpv nti/nq/i m MILLPLACE ESTATES LOT 2 ��K�8l- �� °�(l11�� PERMIT / r� OSP201188 . .�� !!10'UTILITY EASEMENT \ ~/ N / �� 015-112-55 " .�� rr ~ . ( ~�� ^ ~ . ---__ | IV MILLIFILACE ESTATES LOT 1 / . WELL 15'T&E EASEMENT (2008-062329-0) �O'BUILDING SETBACK '1000 -GAL SEPTIC MANWAY ` \\ TH(1990) ' svi10'UTILITYEA8BNENT \ | \\ (73'59) �| EXISTING o1. LomGx3'vwoe.12' \ EFFECTIVE DEPTH ABSORPTION / i | TRENCH | =—| | 10'UTILITY EASEMENT�^ ALTERNATE SITE A B � -`-^ / .. .~-.`"."^�`. | | p008-062330-0/ !� \ 00 PLAN AS -BUILT 0 50 100 LEGEND C0 -CLEANOUT 2CO-DOUBLE CLEANOUT FCD-FOUNDAT|ONCLEANOUT F8'FLOW SPLITTER VALVE MH - MANHOLE MT-MON|TOR|NGTUBE GV-SEPT|CVENT TH'TEST HOLE | 11 A MILLPLACE ESTATES LOT 2 I N E E R I H G %-I %J . 1; I I fii PROFILE AS -BUIL -1 Development Services Department ` Phone: 907-343-7904 w On -Site Water & Wastewater Section Fax: 907-343-7997 H Log Permit Number: # 201391 Date of Issue: 9-24-20 Parcel Identification Number: Date Started: 10-20-20 Date Completed: 10-22-20 Is well located at approved permit location? Yes Q No ❑ Legal Description: T1 2N R3W SEC15 Lot16A Property Owner Name Bir Address: Kvernplassen Paul & Theresa 4220 E. 104th Ave Anchorage, AK Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To Stick up 0 2 overburden 2 3 silt & gravel (tan) 3 60 moist sand 60 70 wet sand & gravel 70 75 silt & gravel 75 100 hard pan 100 120 wet gravel 120 125 gravel w/ little water 125 130 silt & gravel (dry) 130 138 rock layer 138 145 gravel (wet) 145 155 coarse gravel w/ H2O 155 160 61007-557' 1490 48.200' Water Sample Results: Z Y� 2-0 Z' - Arsenic: ug/L Nitrates: A. 3 5- _ mg/L Total Coliform Bacteria: IVF Q colonies/100mL Method of Drilling FE� air rotary ❑ cable tool Casing type: steel Wali Thickness: •250 inches Diameter: 6 inches Depth: 160 feet Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 135 feet Pumping level: feet after hours pumping __gpm Recovery Rate: 4.5 gpm Method of Testing: airlift Well Intake Opening Type: E] Open End ❑ Open Hole ❑ Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite Volume: 2 bags Depth: 20' Start 0 feet Stopped 20 feet Well Disinfected Upon Completion? Yes No Method of Disinfection: tabs Comments: Well Driller: Johnny Kay Company: Hefty Drilling, Inc. Mailing Address: P.O. Box 112130 Anch AK 99511 Attention: The well driller shall provide a well log to the On-site Water and Wastewater Section within 30 days of completion. (907) 343-7904 [��urnp Installation Lot Pump Installation Date: 9-d,- al Pump Intake Depth Below Top of Well Casing: 16jO feet nI Pump Manufacturer's Name: 6rule'ct kK4W� -; 3 Pump Model: Pump Size hp 117 � Pitless Adapter Burial Depth: 10 feet Date of Issue: Pitless Adapter Manufacturer's Name: Cak-,16al 6 -/Vi Pidess Adapter Installer: Pkl--7 PT111 1`5 Well Disinfected Upon Completion? 4 Yes F] No Method of Disinfection; Pump Installer Name: Johnny Kay Hefty Drilling, In'l Attention: The pump installer shall provide a pump *installation log to the DSD within 30 days of pump installation, I l ELMORE ROAD ,, c. !'.: 00005'00"W 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: OSP201188 Work Type: SepticTank Upgrade Tax Code Number: 01511240000 Site Legal Address: T1 2N R3W SEC 15 LT 16B G:2536 Site Mailing Address: 10501 ELMORE RD, Anchorage Owner: KVERNPLASSEN PAUL & THERESA L Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: O,m`nt S' Department 6/25/2020 6/25/2021 dDR16.1 ❑ Disposal Field 2 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 (2417). 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 ' 7r!j 91 — __ 44-7 Date: bJ2_��12_�_ Date: 3 MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program ANCHORAGE Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-112-40 Property owner(s) Paul & Theresa Kvernplassen Day phone 229-8800 Mailing address 4220 E. 104th Avenue Anchorage, AK 99507 Site address 10501 Elmore Road Anchorage, AK Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T1 2N R3W Sectlon*15 Lot 16B Lot Size 91,069 Sq. Ft. Number of Bedrooms --M ee (3� APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank 19Upgrade R Duplex (D) ElHolding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is'in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 0125- Waiver Fees: Date of Payment: Date of Payment: Receipt Number:Qc�JY OBJ Receipt Number: Permit No. Q3ryZ%M Waiver No. Permit App_-'-:- COVID_ 9 257o DISCOUNT APPLIED PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) June 18, 2020 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: T12N R3W Section 15, Lot 16B – 10501 Elmore Road Well and Septic System Design Dear On-Site Services Engineer: The septic tank on the subject property has passed its useful life and must be replaced. We are submitting this application for a permit to construct a new septic tank. The attached site plan identifies the location of the proposed and existing septic tank sites. No conflicts exist between this proposed tank location and any other well or septic system, whether on this lot or adjacent lots. This lot and Lot 16A to the north are currently undergoing subdivision into three lots. No home is currently on Lot 16B, but the septic system will become part of the new lot created through the subdivision. The new septic tank will be placed near the same location as the existing tank. Storm water drainage will not impact this site. Wells on this and adjacent lots are shown. The new tank will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the absorption trench. No surface water is within 100’. Please refer to the attached plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201188, Rebecca Carroll, 06/25/20 10050 0 FEET 1"=50' NOTE: NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED SEPTIC SYSTEM ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS. CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND T12N R3W SEC 15 LOT 16B ELMORE ROAD6/18/20 10' UTILITY EASEMENT (73-59) 15' T&E EASEMENT (2008-062330-0) 10' UTILITY EASEMENT (73-59) 30' BUILDING SETBACK (73-59) 10' UTILITY EASEMENT (73-59) 10' T&E EASEMENT (BK 141, PG 940) 15' T&E EASEMENT (2008-062329-0) EXISTING WELL DECOMMISSION EXISTING SEPTIC TANK PER M.O.A. CODE. EXISTING ABSORPTION TRENCH EXISTING WELL SV MH 2CO 1,000 GALLON SEPTIC TANK w/20" MANWAY Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201188, Rebecca Carroll, 06/25/20 1 "=40' PLAT NO. 73-59 LOTS 16A & 16B SUBDIVISION LOT 16B 91,260 S.F. II II II I y+e I I I �EfOSTxG I �ejs BUIIDING I II I I II I I II I I II I I II I II I I II I I I I PROBDSm NflW IflT UNE I I II 1 I II 1 I II I I II 1 II I I II I I II 1 I II ® I ) ana I 01 I I I I II I I II 1 30' BUIDING SEIBADx 1 I I I (T3-58) I 15' T. k E ESYT. I I I <2006-062330-0) I to UTIM ESMT, (A-59) Y -ARIIT)_ AS -ti U I L I I HEREBY CERTIFY THAT I HANE SURVEYID THE PROPERTY DEPICTED ABOWE ANO THAT NO GASTALDI LOUD SURVEYINS, LLC ENCROACHMENTS EXIST EXCEPT AS INDICATED. JEFF A CASTALq, R.LS. N R THE RESPI 131 OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY F ENTS, ZOOD E DONIINC RD., SUITE 3 COVENANTS OR RES RICRONS MOH 00 NOT ANCHORAGE. AASXA 8960] APPEAR ON THE RECORDED SUBOMSION PIAT. PHONE 213-5154 UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED MR CONSTRUCTION OR FOR GRID MTE 5W2536 1/7/2020 ESTASUSHING BOUNDARY OR FENCE UIEB&, ANCHORAGE RECORDING DIBIR=. AlASNA F.B. JOB NO. NOTE NO CORNERS SET THIS DATE 2020 -OI NILL1N3 9/24/20 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. 015-112-41 Property owner(s) Paul & Theresa Kvernplassen Mailing address 4220 E. 104th Avenue Anchorage, AK 99507 Site address Same Day phone 229-8800 Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T12N R3W Section 15 Lot 16A Lot Size 91,279 Sq. Ft. Number of Bedrooms Three (3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo AD U) Septic Tank ElUpgrade ❑X Duplex (D) ❑ Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑R 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. (Signature of property owner or authorized agent) Permit/Rush Fees: 41623,75 Waiver Fees: Date of Payment:ZI6.1Z0 Date of Payment: Receipt Number: 0137a40 Receipt Number: Permit No.Waiver No. Permit App_''- : - PO BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) September 15, 2020 MOA Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Subject: T12N R3W Section 15, Lot 16A – 4220 East 104 th Ave. Well and Septic System Design Dear On-Site Services Engineer: The owner of the subject lot intends to drill a new well for the future subdivision of this lot and Lot 16B. The attached site plan identifies the location of the proposed and existing well sites. No conflicts exist between this proposed well location and any other well or septic system, whether on this lot or adjacent lots. This lot and Lot 16B to the south are currently undergoing subdivision into three lots. No home is currently on Lot 16B, but the septic system will become part of the new lot created through the subdivision. The new well will be placed near the proposed north lot line of “Millplace Estates Lot 2”. Storm water drainage will not impact this site. Wells on this and adjacent lots are shown. The new well will be a minimum of 100’ from all septic components. Please refer to the attached plan sheet for the design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201391, Rebecca Carroll, 09/24/20 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP201391, Rebecca Carroll, 09/24/20 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 z - `/ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES `-V+ G TO SEPTIC ABSORPTION Address FROM WELL _ TANK FIELD Phone(s) Permit No. No. of Bedrooms WELL ` (> .z E 2_0/-I 3 LEGAL DESCRIPTION LOT LINE (vc� t �— Lot Block Subdivision ! V (--! I ~ '— FOUNDATION L' t 10 t -- Township, Range, Section 1 AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, — \ � _� IA) driveway, water bodies, etc.) TANKS M SEPTIC ❑ HOLDING t Manufacturer Capacity in gallons 1t' IA ni UOQ Material No. of Compartments TYPE OF SYSTEM c ��0 5 cllI ($J TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade original grade 4 FT FT I f Fill added above original grade Gravel depth beneath pipe 0 FT FT I Gravel length Gravel width I FT 3 FT I I Total absorption area Distance between lines cc ( SOFT FT J Number of lines Soil rating Pipe material I Z(6 SQ FT ASTn1 N3O3`/ 0C— I Installer Date Installed _ �i �C' - � i —I � o r✓ c1' I - c cv n'1 -r JeCcI C_f1t1; Ll `l'(�L3 �. S WELLS ❑ PRIVATE ❑ OTHER (Identify) 2 Classification (A,B,C) Total Depth Cased to L FTJ FT Installer Date Installed: 26 I REMARKS: If Al I�2 Scale: N . T-, 5 €NStN' *t Inspection§ Performed by: ' a '" m a r� A r Dale: C%µ`r, j v" 5 ENiGIMEER."PAG I 17034 Eagle River Loop Roacl 1�0. 20,1 certify that thi nspection was performed according to all X. � k s A. Eagle River, Alaska X57 � / ar z 7e`'bfi �y Municipal and State guidelines in effect on this date: Z. �" {� 10 Health Department Approval: Date: 72-013 (3/85) I::;Iqi~ i I",ll:: i 71::'.~;;; I:'1 ~ii',i,, I ! I:l "; I::'l; H:P! [ I i 5~ ) !i~F;l~l;,') I::l;!l':~ ! I!157 I:iX ).',~! ;I Ixi(} :;!!, i~)~:i'I"l,, Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street. Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST AL) DATE PERFORI LEGAL DESCRIPTION: 1 2 3 4 7 8 9 10 11 12 13 14 15- 16- 17 18 19 20 Township, Range, Section: "'"~'t~-/'4 .,'~-~'~,. MJ .~ '~E.r_, ii>- SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? IIepth lo Waler Alter Monilaring? _~ Dale: ~-~,,~0 Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE '7~"~_ (m~nutes/mch) PERC HOLE DIAMETER TEST RUN BETWEFN ~_~ AND "] FT COMMENTS J / PERFORMED I~& S ENGINEF. P. ING ,', ~ // / /~ ~ l ~3N' E.,te RIv~r~, ..~--~~ CERT,FY THAT T~ TE~T WAS ACCORDANO~¢"~'=~¢~OIPAL GUIDEt_INE~/FECT ON THIS DATE DATE: PERFORMED IN Municipality of Anchorage Development Services Department Building Safety Division ~...~.y on-Site water & Wastewater Program 4700 South Bragaw St. i~ P.O. Box 196650 Anchorage, AK 99519.-6650 www.cLanchorage .ak .us (907) 343-7904 . RTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 015-112-40 1. GENERAL INFORMATION Expiration Date: Complete legaldescription T12N, R3W, SECTION 15; LOT 16B Location (site address or directions) 10501 ABOTr LOOP ROAD * ANCHORAGE, AK 99516 Current Property owner(s) Mailing address IRENE DeFRANG Day phone 258-2284 Lending agency Mailing address Real Estate Agent Mailing address Day phone CONNIE FIEIIINGA w/ COLDWELL BANKER Dayphone 2525 'C' STREET * ANCHORAGE, AK 99503 229-4783 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site 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 Ctass C well and may be reissued with new water samples. (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. Note: Alaska Water and Wastewater Consultants, lnc. shall be paid $ at, or pdor I to dosing for the engineering services provided. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I vedfy that my investigation, based on procedures outlined in the Health Authodty 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 inspe~'on, 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 tir~e of installation. NameofFirm ALASKA WATER &: WASTEWATER CONSULTANTS, INC. Phone 337-6179 Address 6901 DEBARR ROAD. SUFrE 2B * ANCHORAGE. AK 99504 Engineer's Printed Name JEFFREY A. CARNESS, P.E. Date Engineer's Comments: In conducting this evaluation, AKVVWC, Inc. attempted to provfde a thorough. conscientious engineetthg analysis of the system in accordance with ADEC and MOA DSO Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life o fall wells and septic systems depend on the local soils condition, greundwater levels that may fluctuate during the year, and the water usage of the family being sen/ed by the system. These conditions are outside the central of the evaluator of the system. SatisfactoQ/ test results do not guarantee future performance of the system, nor do they guarantee that there ere no hidden defects or encroachments. AKWWC, Inc. can therefore not pro~dde any warranty or future estimate of how long the system will continue to meet the operational requiraments of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE Note: ~ere are nitrates present. ~"-" ON SITE Approved for ~ bedrooms. Disapproved. Conditional approval for bedrooms, with the fllowing stipulafio~O~ ..... ' Thw well for this properFy meets existing state It is suggested that periodic testing be performed to insure the wells continued suitability, The current nitrate concentration is~8.48mg/1. EPA maximum concentration is 10.0 m~/1. More information on n. itrates is available from the On-site services program, at 343-7904. Att~:fiments: HAA Checklist I.,,,/ Manitenance Agreements Septic System Advisory Supplemental Engineer's Reort Well Flow Advisory Other Original Certificate Date: Municipality of Anchorage Development Services Department Building ~afety Division On. Site Water & Wastewater Program 4?00 Soufft Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www,d.anchorage.ak.us (sm,) ~43-?;04 Legal Des=lpUon: A. WELL DATA HEALTH AUTHORITY APPROVAL CHECKLIST T12N, RSW, SEC. 15, L16B PamallD: 015-112-40 Well type PRIVAI~ IfA, B, or C provide PWSID~ N/A. Date completed PRE 1990 Sanltaryseal(Y/N) YES Totaldepth 133'+ ft. Date of test Static water level Well predudion ~ WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Amenio: N/A mgJL. SEPTIC/HOLDING TANK DATA Cased to 40+ ft. FROM WELL LOG 8/8/84 UNKNOWN ft. 2.5 g.p.m. Nllmte 8.48 mgJL Date of sample: 7/19/2002 Tank Typa/Mata~tal STEEL Tank size 1000. gal. Number of Compartments Foundation deanout (Y/N) YES 2 Depression over tank (Y/N) N,O. Well LJ:,g (Y/N) Wires propedy protected (Y/N) Casing height (above ground) AT INSPECTION 7/19/02 129 It. 5+ g.p.m. YES YES 124- OUler bacteria 0 colonlesJ100 mi. Collected by: AKWWC, INC. Date installed 9/24/1gg0 Cleanouta (Y/N) YES High water alarm (Y/N) N/A Date of pumping 8/12/2002' Pumper DENAU SEWER AND DRAIN pBELOW EXIEI1NG GR,'U)EI Soil rating ~ lt~/Ixlrm) 268 ABSORPTION FIELD DATA Date in,steWed e/2~/1~90 Length 51 fl. Width 3 lt. Totaldeplh ,12 ft. Eff. abso;ptlonarea 816 fl= Monitodngtube YES Date of adequacy test 7/19/2002 Results (Pass/Fall) PASS Fluid deplh in absorption field before test 0 in. Water added 1180gal. Elapsed Time: 1188 min. Flrml fluid deplh 19 in. Absorption rote >= Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN System type TRENCH Gravel below pipe 8 lt. Depression over field NO For 3 beqmoms New deplh 51 in. 4504- g,p.d. If yes, give date - D. UFT STATION Date installed 'Pump on' level at in. Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Fe Size in gallons 'Pump off' le~ at Cycles tested SepUc tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer IsepUc service line 25'+ Manhole/Acee<- ("(/14) High water alarm level at Meets alarm & drcult requirements? On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/oleanout Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Water main N/A Water service line 10'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Water service line 10'+ Curtain drain NONE KNOWN COMMENTS Building foundation 10'+ SurPace water 100'+ Wells on adjacent lots 100'+ G. ENGINEER'S CERTIFICATION I cattily that I have determined through field inspections and review of Municipal recortls that the above systems are/n conformance v/~th MOA HAA guidelines in effect on this date. Engineer's Printed N~me Date JP.J'F~EY A. GARNESS Absorption field 5'+ Bur[ace water 100'4- Date o, P, nt 15- (~. ~) Water main Driveway. partdng/vehlcte storage Waiver Fee $ Date of Payment Receipt Number in. 10'4- •08}09/2002 12:15 40.0 2728738 HILDONEN rg e 5 2' 3 T ,. 45.P Y e, n.c "Jew. •�aV— y �gENFR t yf. DO SYfIGS \ O t F+ �{ 1. 9±A CRE3 3 { 1.1 q o { z i P^' EASEMENTS OF RECORD, OTHER THAN THOSF SHOWN ON THE PD LAT, ARE NOT SHOWN HEREON_ 'ASSUILr II m I� l� • SCALE 1 "e 5o' I•f {o WCLL �o I` W -/•ld' urn /rY P5mr• 4,51E 289.}37 THE INFORMATION HEREON 15. FOR THE USE OF LENOING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONPUOTB BETWEEN EaSTING STRUCTURES qND PLXr TED LOT UNES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES OR FENCeUrnss. Book 6 7 P9 NO corners set - ne:eay ceNH Incl I Teva surveyee the loeovAng deetIflbes propeM. Let 16i3 BID°k — y/�p�e••••I•• 1_'•,`r•I IN gy/ `/tl SEG. r5 TI2N R3W anenoraga ramrdlnp dkslrin AiRsk°. Rnd tnR2 the 'lmprovamartle ^Imaled tnerean Bio wltnm the praperry linea end d° nol ovenep of eecr°°d, pn � t �4g L� ZA 1Fe pnoparty pn9 adleaent fnmefo. nrn ea imPro�ememe on Properly IYln9 etlleC9n11°ereta aneroaenonlbapremisesin9ae^ri0^^^dl^®ltrwre ue^pf°edweys, Nenelnleslan llnw ar oPar Ig 5 er ri HI1d°nen r,is4bls easement6 m said Pr°PeM exupt°e In"Ied MNon. �t'Bs -.•• No. I70eS AlN7lpfape. AkWre 4' J-ULY 7002-