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HomeMy WebLinkAboutMADDUX PARK LT 3Maddox Park Lot 3 rvIuNIUPALITY OF At4CH'CRAC` DEPT n:�_ _,- 'NT MUNICIPALITY OF ANCHORAGE ` AL P'" IECT)ON / r DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION SEP ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720, ON -SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION `IiEP&4:fY1 t,;"r NAME PHONE ❑ NEW S I-EVESr� H REC I-, UPGRADE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEpR00MS DISTANCE TO: Well ! Absorption area! Dwelling I PER IT NO. UY 7 wZ Manufacturer n Materi No. of compartments N Liq. capacity in gallons 1 7 `, IF HOMEMADE: Insidelength Width Liquid depth 2 DISTANCE TO: Well Dwelling PERMIT NO. _ Manufacturer Material "" ' ' L'igLIfd"capacity in gallons w = DISTANCE TO: Well i !, Foundation �� Nearest lot I ny PER,§I� f�. _ .�_ J LL z No. of lines, a Length of eac line Total Ien th of>es it Trench idth Distance between lines �?� iZ: F Top of tile to finish grade ! Material beneath tile ` Total effective aWolption'area iC^ k,eh'es ","LZ U w Length Width Depth PERMIT NO. c7 Q F- wa Type of crib Crib diameter Crib depth Total effective absorption area N DISTANCE TO: Well Building foundation Nearest lot line Class/,3ICjkiA iC Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS t� 3r 3yo SOI L TEST RATING ! INSTALLER �, i A-;' T + �L REMARKS 1 JU ' v r CR A}_lj %2 = _ 26° ►� ! c:S Gr En v 14 N CX i MQt'Y . 71 7 APPROVEDl ' DATE LEGAL 3 t3 a ,•t-� 1� po K 10Ax k �'i2 N 3 r[-ui i (Kev.3//8) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH 825 L STREET, AND ENVIRONMENTAL PROTECTION ANCHORAGE, AK 99501 264-4720 PERMIT NO: 840154 UPGRADE DATE ISSUED: 04/09/08 APPLICANT: STEYE SCHRECK ADDRESS: SRH BOX 4029-1-7! ANCHORAGE, AK 99507 CONTACT PHONE: 345-5415 LEGAL DESCRIP: SUBDIVISION: MHDDOX LOT: '] SECTION: ]] TOWNSHIP: 12N RANGE: ]W LOT SIZE: 17500 (SQ.FT. OR HCRES) BLOCK: NH I CERTIFY THAT: i. I AN FHMILIHR WITH THE REQUIREMENTS FOR ON —SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOH) AND THE STATE OF HLHSKH. 2. I NILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOH CODES AND REGULHTIONS^ AND IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT. I I WILL ADHERE TO ALL HOH AND STATE OF HLHSKH REQUIREMENTS FOR THE SET BACK DISTANCES FROM ANY EXISTING WELL, WASTEWATER DISPOSAL SYSTEM OR PUBLIC SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT. IF /l LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOH BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTHINEDo (2) AS—BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT/ AND (]) THE ELECTRICAL WORK MUST BE DONE BY H LICENSED ELECTRICIAN. SIGNED DATE: APPLICANT—ST — ISSUED BY DHTE: /� ^ '7 '��^---------- ------------ /_/_ °—~—��---- I SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST Pouch 6-650, Anchorage, Alaska 99502 27133-2221 SOILS LOG PERCOLATION TEST A z PERFORMED FOR: DATE PERFORMED: LEGAL DESCRIPTION: (d DEPTH SLOPE SITE PLAN ----- - - (FEET) 2 4- u 5- 6 7 8 9 10 11 12 13- 14--- 15- 16- 17 - 18- 19- 20- COMMENTS Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN - FT AND - FT PERFORMED BY 72-008 (7/76) CERTIFIED BY: DATE: MUNICIPALITY OF ANCHORAGE Department -f Health and Environmental '?rotection 825 Street, Anchorage, AK. )501 264-4720 # # # HANDWRITTEN PERMIT # # Permit #,4C(5a WELL AND/OR ON -SITE SEWER PERMIT Applicant 6+(_uti�',� Mailing Address: Phone Number: r� Location: Legal Description: (i c'- Lot Size: Type of Soil Absorption System Is: Trench: _ Drainfield: Seepage Bed: Holding Tank: Maximum..Number of Bedrooms: _ Soil Rating(sq.ft/br) � The Required Size of the Soil Absorption System Is: DEPTH LENGTH �_ GRAVEL DEPTH WIDTH 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 fortrenghe,s. The gravel depth is the minimum dept cf gravel betwe the?et 1� nd the bottom of the excavation (in feet l•` # # REQUIRED SEPTIC(HGi,&P-i) TANK SIZE _ GALLONS # 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. * # * TWO(2) INSPECTIONS ARE REQUIRED # # # Backfilling of any system without final inspection and approval by this departmer will be subject to prosecution. Minimum distance between a well and any on -site sewage disposal system is 100 feE 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. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. # # # PERMIT EXPIRES DECEMBER 31, 1 9 0 I certify that: (1) I am familiar with the requirements for on -site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on -site sewer system may 70quire enlargement if the esidence7is ;reymoele to include more tha 'edrooms. Signed: _ L-< Issued by• Z App1i nt `- a Date. e SWP/024(1/81) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel 1. D. # \ - o _?a HAA # i � R4 q I) Q _'D L 1. GENERAL INFORMATION Complete legal description e' Location (site address or directions) OR& 41D 11/0 S LV-44-4 1- Day phone Property owner 'AaU4 t2 Mailing address Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone t5_62—) NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on -site Holding tank Community on -site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: tte t 3 H O r,(kU)C CLL� Parcel I.D. A. Well Data Well type g- If A, B, or C, attach ADEC letter. ADEC water system number�/� Log present (Y/N) Date completed ��i7`'1 Driller - W Total depth _� �.� Cased to CG Casing height > / J/ Sanitary seal (Y/N) Date of test Static water level Well flow Pump levell Wires properly protected (Y/N) FROM WELL LOG r �f & 17 fl 19�3 9 Lt0 lei ii.V g.p.m. 'Bn -da" ! ey0 SEPARATION DISTANCES FROM WELL TO: AT INSPECTION MUNIC!PALITY OF ANrHORAGE ` T{RONMENTAL SERVICES DIVISION _ ;14 141993 g.p.m. > Q RECEIVED Septic/holding tank on lot ��%.-�� ; On adjacent lots Absorption field on lot 1/fJ ; On adjacent lots I l 0 Public sewer main/ A Public sewer manhole/cleanout Sewer service line % 0 Petroleum tank K/ I V WATER SAMPLE RESULTS: Coliform j Nitrate Other bacteria Date of sample: 7l ,) �93 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 9 (may Tank size /^0 Compartments - Cleanouts (Y/N) 'IL Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) Alarm tested (Y/N) t46� Date of pumping 1zi 3 Pumper At SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I )L5 On adjacent lots > /c 3 Foundation i ( To property line `) PL& Absorption field Water main/service line < <% Surface water/drainage 72-026 (3/93)• Front CONTINUED ON BACK PAGE L ,t4TIO0'OF WELL (Plooss comolblo, oithor io, lb or le.) aroygh Subdivision Lot @took Ib. 1/4gtrs. It%lk—of—of_of —,. i!►�pNcti 'AND OIRECTION�jFROM, RDA INTERSECTIONS 11tto4f Addfget odd Area of Well Localton WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Potrnlf No, A.O.L. No. Section No. Township NO "onto EQ Merldian sp Wo 3, OWNER OF WELL. Address: Foot B#law St, WELL,LC6 ' surface Material Typo Top- @ottonM M, .. . _. 3111 4. WELL DEPTH: (final) 3. DA)VE OF 00�M�qPLSTION 4, C]Cabt♦ toot G skolory 00rivon Dug�� 11 Auger [] J•tled Q Bored Other t 7,USE: RDameetls D Pubilo Supply Q Indutatry Q irrigollon [J Roohorge ❑ Dommerlodl 0 Tut Well 0 Other: NG; Q Threaded _ 0 Welded J*� diafn in, to r,' �Mt Depth Weight fbs, f ft, dtam, In. to ft. Depth stlokup,r of. ti. FINISH OF WELL 1.. Type: Dtomettrs Slat%Mitt�t Sit#. _ ___ Length: _ Sol bolwotn ff, and Backfillinq Gravel paek 10—STATIC WATT=R. LEVEL!� tt. © Above or 0 Below land surfodi Oa Equipment used: II I. PUMPING LEVEL below land surface and'YIKd 0 Qft. after — hro. pumpin0� ¢.p.m. ft. offer hrs. pumping —il'o.m. 12.OROUTING Well Grouted; 0 Yes 0 No Material: Q Neat Cement ❑'othot: In,* PUMP; (if ovalidb s) HP _ Length of Drop Pipe It. copaoHY C3 Subm, CJ Jet © C#ntrifical 0 Other a 14,REMARK3• d IC WATER WELL CONTRACTOR'S CERT•I1`IcAT1ON; ItS. WaI#r Temperature —° f Thlt will was denied cllon and this regart 11; true to the bust. I my knowledge and belief; 1114141.1.0d Busiest Nomo t Contract Licensei Nvroboe a4 .rf Ar 1 J Signed: ~ Authorized R#pree4 (alive Date: J-- / 11-1 C Copy Distribution: WNItE'Stoto DOGS, P1NK-Drll,lerr CANARY-Guotpm#r. DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPE TOR INSPECTOR INSPECTON! IC;IPALITY OF ANCHORAGL DEPT. OF i'_ALTH & MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 1�7f} n 825 L Street - Anchorage, Alaska 99501 1 J P ! J ENVIRONMENTAL SANITATION DIVISION RECEIVED Telephone 264-4720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNER PHONE MAILING ADDRESS PROPERTY RESIDENT (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS 3. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE NUMBER OF,BEDROOMS ❑ SINGLE FAMILY ❑ One ❑ Four ❑ Other ❑ Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY ❑ INDIVIDUAL* * ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM INDIVIDUAL/ON-SITE** YEAR ON -SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 1 1 �� � �"+ o MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON -SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ]'NEW c ` 1J`77LI ❑UPGRADE .JC/1✓PCB . MAILING ASS !G LEGAL DESCRIPTION L C, T ^ / r/�� / /, J /� C r J ' l LOCATION NO. OF BEDROOMS , AT c= t�_ 0F.- e ni o(wn-/) 13 DISTANCE TO: Well Absorption area i 5 Dwelling PERMIT NO h U Y � V45 wZQ Manufacturer J p Materi ( No, of �oinpartments H e ( l �� Liq. a acity i. gallons ( �o IF HOMEMADE: Inside length Width Liquid depth DISTANCE TO: Well Dwelling PERMIT NO. J z = z FQ- Manufacturer Material _ LiquAcapacity in gallons w= DISTANCE TO: Well Foundation Nearest lot line i PERMIT NO. C��� ✓� J LL z No. of lin��s Length of each line Total length of lines Trench width f- Distance betweien lines 1-? CJ � �- 2 ( inches 11 GIL Im Top of tile to finish grade Material beneath tile Total effective absorption area inches _--�(p Length Width Depth PERMIT NO. w 0 _ Q I- wa Type of crib i diameter Crib depth a effective absorption areaJ y DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO: J (� a_ w 3: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER _ PIPE MATERIALS 7) 3� SOIL T T RA G ) INSTALLER REMARKS I ro fl ^� AP ROVED DATE LEGAL 4 Z fi X-1 Ll 77-M3 IRav 3/7RI / ���I MID I Fo, VAk_ :11 '!_ "w" !IN F:, 1"! 14 c? FA Cy Az FA C3 K DEPARTMENT OF HEALTH HHL ENVIRONMENTAL PROTECTI0N 825 'L' STREET, HNCHORHGE. AK 93501 264-4720 - 75 1 0- EE .4 F? K EE Fv �-' PERMIT NO. ( 790245 ) APPLICANT STEPHEN SCHRECK SRH BOX 4029 2 LOCATION MHDDOX PHRKLEGAL LOT po-"Q- LOT SIZE ~ ~?' -- � �7U`i - ' . 17500 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = Z SOIL RATING (SQ FT/BR)- 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 71,(IN I_EEL K! �_�3 -1��= THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFHCE OF THE GROUND RED 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 OUTFHLL PIPE RED THE BOTTOM OF THE EXCAVATION (IN FEET) own—T I 011 7- 10 "K K ��fC.-.--,.-.= ­_e3e3(a PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE INSTALLATION INSPECTIONS OF ANY' WELLS ADJACENT TO THIS PROPERTY HND THE NUMBER OF RESIDENCES THHT THE WELL WILL SERVE. 0- Kj CA c: 22 Do 114155 Foy EE: 1:� K I K7p �, F'r, EE ��CA k- 9 :1 F;�-- U`,�K ___ BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION RED APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND RNY ON -SITE SEWAGE DISPOSAL SYSTEM IS 108 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL RELL 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 HRE AVAILABLE TO INSURE PROPER INSTALLATION. E>EEK0K&%?1=E FRI I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON -SITE SEWERS RED WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I W}LL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN BED------------- RO =.:.-`PIcn SCnRcC^ h w l.. I w vv C::# F::-- ��1 6. !-:Rl. �.­-,� p-li�� DEPHRTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, HNCHORHGE, AK. 99501 264-4728 L.4 L_ L_ F­ll p"l K1. t.)*A 1 1—' ���� F`:1 P1 l: "I PERMIT NO. ( 780761 ) APPLICANT STEPHEN SCHRECK SRH BOX 4029-2 279 7392 LOCATION MHDDOX PARK S/D LEGIF! L L] MHDDOX PARK S/D ~- LOT SIZE 17500 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)- 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: Clk"00"0_10-4= -ILCT 2al" E> El F" -F 11= � [HE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD THE DEPTH OF H 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 THEE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM Oh THE EXCAVATION (IN FEET). K�K-.q 1 F;�_"EET K> it E= FO -T- 1 10 All"! 04 bc 15 p. -j �,. _-0 t� _K_P-4 �'-.-.7.5. PERMIT APPL1c|1N! IAS TFE RESPONST010ITY,TO INFORM THIS DEPARTMENT DURING THE INSTALLATION PROPERTY AND THE NUMBER OF RESICENCQ THAT THE ke.L WILL SERVE. -` ______ -��4 ��� BHCKFILLING ANY SYSTEM 11I D APPROVAL BY THIS ' DEPARTMENT W'LL BE SUBJE[�T T[��ROSECUTION/ MINIMUM DISTANCE BETWEEN-H WELL HND HNY ON- DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL/ OR L~�=- 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE 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. E1041"lFTEEITT ���: -� E I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED: ........ APPLICANT STE � ��� ISSUED BY 0/ DATE �] -�~ �� Y] 2 -----=- �----�--_/�'------- --------------- � U (j December 29, 1978 z.'780761 Stephen Schreck Star Route A Box 4029-2 Anchorage, Alaska 99502 Subject: Lot 3 Maddox Park Subdivision A permit issued by this department for well and/or sewer syste_�i has expired. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal ordinance. If you have drilled the well, a well log should be sent to this department to document the installation elate. If there are any further questions, please contact this office at 264-4720. Sincerely, Les N. Buchholz, R.S. Senior Environmental Specialist LN'/ljw enc : copy of permit r'l k.1 04 1 1: F- 03_ :�r "T' (:1107 101 r4 CT hi L. 0 FA Cl E..-:.-*-' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 'L' STREET, ANCHORAGE, AK. 99501 ' 264-4720 �FEE �L.. 10 01 EDN 1-1 �_R;: E_: 13 E07 L4 ERE IN: �& 101 lwl 1 -1'** PERMIT NO ( 780761 ) APPLICANT STEPHEN SCHRECK SRH BOX 4029-2 279 7392 LOCATION, MHDDOX PARK S/D LEGAL L] MHDDOX PARK S/D LOT SIZE 17500 SQUARE FEET TYPE OF SOIL HBSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND HND 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 OUTFHLL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET) I F"EEEI ��0"*-T­ I II: P.- f0bil< 15 1��= 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. �14 lC'.k < :2 :1 1 rA 53 FT"FEE 10; -T- I 11104 NET 10 IT:: I " ��t_j I I&? IERI 10 BHCKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AND ANY ON -SITE SEWAGE DISPOSAL SYSTEM 100 FEET FOR H PRIVATE WELL/ OR 150 TO 200 FEET FROM H 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. Fo"E17 100 rwl X 0- IRR53-:11, 1: [:>EECVEHPlEAlEFFT 00^ 1- so To &R-*` I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I: I UNDERSTAND THAT THE ON -SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOM! ^ 7-1 SIGNED:__ _ - -- — HPG��I�R�T ST CHR ' - ISSUED BY___�_ �L......... DHTE___---------------- Y3.2 �/ , _ Municipality of Anchorage 0 Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street A F C T�;OK P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 V CERTIFICATE OF ON -SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 018-252-03 COSA# 091f- /0/3/2 Expiration Date: 71 1. GENERAL INFORMATION Complete legal description Maddux Park, Lot 3 Location (site address) 4640 lvo!-y Drive Current Property owner(s) James Cammon Day phone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone Bob Bear / Dynamic Properties Day phone Unless otherwise requested, COSA will be held by DSD fdr pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 7 0 Individual On -site Individual Water Storage 0 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 On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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. Municipality of Anchorage Development Services Department V Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON -SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Maddux Park, Lot 3 Parcel ID: o18-2 1-0 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed :L/3.q/3.989 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth iq5 ft. Cased to igs ft. Casing height (above ground) 2_in. FROM WELL LOG AT INSPECTION Date of test i/ig/ig8g ii/8/2010 Static water level 3.03. ft. 95 ft. Well production 100 g.p.m. 7.0+ g.p.m. .., .. .,.,, , .",�� , Coliform Neg colonies/100 mL Nitrate 0 ` t, mg/L Other bacteria Neg colonies/100 mL Arsenic: ug/I Date of sample: 2 s 2011 Collected by: DRM B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer/Steel Date installed 8/8/3.984 Tank size 3.250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm�(Y/N) N Date of pumping 6/14/20i0 Pumper Alaska Sewer & Drain C. ABSORPTION FIELD DATA Date installed 8/8/1984 Soil rating (g.p.d./ft2 or ft2/bdrm) 85 SF/BR System type Deep Trench Length 34.5 ft. Width 4 ft. Gravel below pipe 6 ft. Total depth -io ft. Eff. absorption area 414 ft2 Monitoring tube Y Depression over field N Date of adequacy test 13./8/2010 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test o in. Water added622 gal. New depth23 in. Elapsed Time: ioo min. Final fluid depth o in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date Municipality of Anchorage r"t, " Development Services Department 0"j, Building Safety Division On -Site Water and Wastewater Program 5 A F 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON -SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o18-2q1-03 COSA# 0-�C/0/3/,2 Expiration Date:. 1. GENERAL INFORMATION Complete legal description Maddux Park, Lot 3 Location (site address) 2640 Ivory Drive Current Property owner(s) James Cammon Day phone Mailing address Lending agency Mailing address Day phone Real Estate Agent Bob Bear/ Dynamic Properties Day phone Mailing Address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage M Community Class Well M Public Water System El TYPE OF WASTEWATER DISPOSAL: Individual On -site 0 Individual Holding Tank El Community On -site El Public Sewer El The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of On -Site Systems 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 yngineer's work. iz-Il Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON -SITE SYSTEMS APPROVAL CHECKLIST Legal Description: Maddux Park, Lot3 Parcel ID: oz8-251-03 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed :L/iq/3.q8q Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 3.gS ft. Cased to —3S—ft. Casing height (above ground) 25 in. FROM WELL LOG AT INSPECTION Date of test i/i9/i98g 11/812010 Static water level 103. ft. 95 ft. Well production zoo g.p.m. 7.0+ 9-p.m. WATER SAMPLE RESULTS: Coliform Ne_colonies/100 mL Nitrate 0.468 mg/L Other bacteria Neg colonies/100 mL Arsenic: ND ug/I Date of sample: 11/8/2010 Collected by: Pannone Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer/Steel Date installed 8/8/1984 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping 6/14/2010 Pumper Alaska Sewer & Drain C. ABSORPTION FIELD DATA Date installed 8 8l /2984 Soil rating (g.p.d./ft2 or ft2/bdrm) s SF/BR System type Deep Trench Length 34.5 ft. Width 4 ft. Gravel below pipe 6 ft. Total depth io ft. Eff. absorption area 414 ft2 Monitoring tube Y Depression over field N Date of adequacy test 11/8/2010 Results (Pass/Fail) Pass For & bedrooms Fluid depth in absorption field before test o in. Water added632 gal. New depthz3 in. Elapsed Time: ioo min. Final fluid depth o in. Absorption rate >= 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date ** p �' 49 TH g �Q VO .Ant ny P. Ho fman; LS-9020 LOT 5 ®�Q °fessiono� �'d� f NQ0 0,�`� Found 5/8" O y, Rebar - O r F o �01.1 Found 1 1/2" Alcop LOT 2 txa' SHED LOT 3 17,341 sq.ft.f O o 0 O CO �O M `yro- '� s F LOT 4 ........... G Set 6" Spike (Typ) �150 Zs� 19.4 (s , `bf°� �Iklp Municipality of Anchorage o Development Services Department Building Safety Division` S. cTr On -Site Water and Wastewater Program 4700 South Bragaw Street 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 I.D. 018-251-03 HAA # C �= Expiration Date: — ! 3 - 0 3 1. GENERAL INFORMATION Complete legal description Lot 3 Maddux Park Location (site address or directions) 2640 Ivory Drive Anchorage AK Current Property owner(s) Joe Caperton Day phone 339-6500 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address 3900 C Street Anchorage AK 99503 Day phone Day phone Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual On -site Individual Water Storage ❑ 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 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. DSD 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. (Rev. 11 /99) Municipality of Anchorage AVE ' Development Services Department `a Building Safety Division a On -Site Water and Wastewater Program 5 4 E T Y 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description. Lot 3 Maddux Park Parcel I.D.: 018-251-03 A. WELL DATA Well type P If A, B, or C provide PWSID # Date completed 1/19/1989 Sanitary seal Y Total depth 195 ft Cased to 195 ft FROM WELL LOG Date of test 1 /19/1989 Well Log Y Wires properly protected Y Casing height (above ground) 25 in. AT INSPECTION 5/21/2003 Static water level 101 ft 96 ft Well production 100 g.p.m 6.67+ g.p.m WATER SAMPLE RESULTS: Coliform colonies/100 ml Nitrate c ' ` `mg/I Other bacteria colonies/100 ml Date of sample: 5/21/2003 Collected by: Laura Pannone B. SEPTIC/HOLDING TANK DATA Tank Type/Material Greer Steel /a7 7Q Uri y,'na I Date installed 8/8/ 984 q� Tank size 1250 gal Number of Compartments 2 Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm N/A Date of pumping 5/21/2003 Pumper A+ Home Services C. ABSORPTION FIELD DATA Date installed 8/8/1984 Soil rating (g.p.d./ft2 or ft2/bdrm) 86 System type Trench Length 34.5 ft R ' I Width 4 ft Gravel below pipe 6 ft Total depth 105" ft' Effective absorption area 414 ft2 Monitoring tube Y Depression over field N Date of adequacy test 5/21/2003 Results (Pass/Fail) P For 4 bedrooms Fluid depth in absorption field before test PU in Water added613 gal. New depth? in. Elapsed Time: 50 min Final fluid depth Pry in Any rejuvenation treatment (past 12 mo.) (Y/N & type) N (Rev. 11/99) Absorption rate >= 600+ g.p.d. If yes, give date own FHSHED FtDart EY. (ADD) `r R� OO 5 t'o( Vj D l EV (ASSUttED . 1 P NNG DISC o_ IDNT WJ DNO SEMAO( z v o •i T DE 9ULDN4 SETRACK -M DULDND SEMA« 2 0�; 16` 4 Gl T/L F5 / j T - - -- EAST- Prepared by SURVEY CERTIFICATIONr1� �rrr of �•�� Robert E. Johns Jr. &Assoc. PLOT PLAN -�-� �.•,�� ��.•, �e Professional Land Surveyors I h—by aUlr I . ph> Y tM Id draw, aW d.= ha.an, sN e,ot I AV (�:. �♦ 842 E. 12 AVE. ANCHORAGE, ALASKA 99501 h -= � Zt. ft - as m,Y, Ma-4d" ad abtR4 d inwrbw haw h..n - ;. � � �� th � 0 Scale, 1 �� _ 30 I Rec. Lot S.F. Rec. Plat Flle No. m.a d W. and aortal. FOUNDATION AS —BUILT y.. •, / Surve d: Drawn by. Checked by. :f...,.. •.. `,1�� ,i •�JK• Date MAY3-2003 REJ MLJ ham,.„ emA�."ehwtYoaWyd:: raw aouan m thl. of aM tl�f U. �••• ••ROBERT t'JOHN �� •,. Dat. Drawn: �Id: 3 0 3 4 W.O. 2 31 2 3 a, �,� d� l/ o MAY 2 3, 2 0 0 3 FINAL STRUCTURE AS —BUILT °f '•., �•,•' • • °°e .....•......•• 6 �� Legal Deecrlptlon: Lot 3, MADDUX PARK SUBDIVISION 4Rob-tEJ-M&.-h.r.Dyawb""tI h— t—.d an Arhlt R.M' d eh. W- d tM ♦/ d P aft ', rofeaelonak ���• .t,,.h_ . thW It and that . d � ava� :,. � . ��rrrrwr�� .na.n atha.lr SYMBOLS ❑ LOT SURVEY SURVEY TYPE ASPHALT • SET REBAR � W DRAINAGE ❑ FOUNDATION AS —BUILT ❑ FINAL STRUCTURE AS —BUILT ... O FOUND REBAR 4, — WOOD FENCE • CONCRETE ❑ PLOT PLAN ... AS —BUILT ... LOT SURVEY ' • ' TOPOGRAPHY SET 00 ASSUMED ELEV. -)FX-- X METAL FENCE WOOD DECK AS —BUILT. _NO CORNERS SET [3 RECFR-nnCATION AS —BUILT ... NO CORNERS PLOT PLANS k LOT SURVEYS NOTE: THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE T IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATIVE ONLY SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE COVENANTS OR RESTRICTIONS ETC., ARE MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. THE EXISTENCE OF ANY EASEMENTS, DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT, I ALL DI TAN E WHICH UNDER NO CIRCUMSTANCES SHOULD AN AS —BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. LIABILITY ONLY FOR THE COST OF THE SURVEY. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.