HomeMy WebLinkAboutSHRYOCK LT 3l C>or 3 72-013 (Rev. 3/78) 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 & !' � /G/9 AUPGRADE MAILING ADDRESS LEGAL DESCRIPTION OT .iter� . s/ '.o LOCATION f' "ll g f/ NO. OF BEDROOMS U DISTANCE TO: Well [7 CJ z Absorption area a 1j 1 Dwelling P ��. Y PZ Z LU Manufacturer (�'/� Material _ }— No. of comp5tments y Liq. capacity in gallons �5�� IF HOMEMADE: th is id-deprt>_ OOz DISTANCE TO: Well Dwelling PERMIT NO. 02< 2N Manufacturer Material Liquid capacity in gallons O Well Foundation / Nearest lot line f PER Alfl�*") � w DISTANCE TO: �j ���(-`!l`�`J J LL No. of lines Length of each line r Total length of lines J Trench width is lines P Z w & �J inches - -- - p�. Top of tile to finish grade Material beneath tile Total effective absorption area o inches & c) Length Width Depth PERMIT NO. ui Q Q F Type of crib Crib diameter Crib depth Total effective absorption area 9.— u! w U) Well Building foundation Nearest lot line DISTANCE TO: Class Depth Driller Distance to lot line PERMIT NO. a W Building foundation Sewer line Septic tank Absorption areals) DISTANCE T0: OTHER i !� i I PIPE MATERIALS PVC SOIL TEST RATING 7� INSTALLER DE 6 /'' oO&) E C, C 3- 0/& U '— •ro c,H RE=MARKS r 6` loll - TcdI ` nmn X _N io' 19N too 14 OCA av,r� LEGAL(o ukto $ A,'A APPROVED DATE C)jlkbei 83 akml�E (LY -6 72-013 (Rev. 3/78) Tli-;F,[ I..'F SOIL. ABSORPTION ,.7Yl-TEI-I P..`,: TREPACH : , F,*:ATING (SO FT/BR)= J.50 t.-UtelBER OF BET-ROO11-5, 4 SIZE OF' '1*'F.IE 5-01L 11S: r If -p P-4 L— Co 11 F - ME LFhIGTH I.X11,10-4,51019 IS THE (IJ -4 FEET) OF THE TRENCH OR DF'FlIhIF'IE*L.D THE. DEPTH O' A Ill": T. F*=ll 0 F 11, _,fl q,,II jl-,-r Ffl" 3 E'�" GRO1. NE -1 MAE) '['HE DE: FFi F., T 1-- 1 EI, -,I T D EhI'ki.' C PA 1, 1 E. I` --I "I" A L. ,'OTE'CTI OtA THERE IS PACI SET I.-J'(E,.,TFI For;:, =,_+"-1 'I"HE CIPMVEL E:,F..'F:,Tl,.l I'-::; 'THE IlItAIP1,111 2 Ifs 4.-. r°-1 FlydD THE BOTT011 OF' THE FEET, F--! C—LI N -J 1 IIRu E.E. F'ERI-111" I' -JO. 11-- 1. C: 1 F9 Ir -4 I E-- :3— F5. Ic--` 030, F�-,fl P.— 0 PA #F:5, APPI SRA E:i*.i::.-' -:1-0:15.- 191,AV-1-1. Ak". I —J. 6 L 0 I. AT' Cit -4 LEGAL L:.0 T S* I Z E FT:.ET Tli-;F,[ I..'F SOIL. ABSORPTION ,.7Yl-TEI-I P..`,: TREPACH : , F,*:ATING (SO FT/BR)= J.50 t.-UtelBER OF BET-ROO11-5, 4 SIZE OF' '1*'F.IE 5-01L 11S: r If -p P-4 L— Co 11 F - ME LFhIGTH I.X11,10-4,51019 IS THE (IJ -4 FEET) OF THE TRENCH OR DF'FlIhIF'IE*L.D THE. DEPTH O' A TREVACH OR PIT 'THE DPE;1TINCE E:E*T14EEhI THE SURFAC.:E' OF THE: GRO1. NE -1 MAE) '['HE BOTTOM OF THE E:,::CAvATj.ot-,i (PA FEET). THERE IS PACI SET I.-J'(E,.,TFI For;:, TFIEP,1CHES. 'I"HE CIPMVEL E:,F..'F:,Tl,.l I'-::; 'THE IlItAIP1,111 DEPTH Of',' CIRFA IEL. BETWEPA THE OUTFALL. PIPE FlydD THE BOTT011 OF' THE FEET, F--! C—LI N -J 1 IIRu E.E. 'S.5,- E=-" IF-` 11-- 1. C: 1 F9 Ir -4 I E-- :3— F5. Ic--` 030, F�-,fl P.— 0 PA #F:5, PER.1-11T APPLICAIAT HAS THE RE'-'--* PID 1-4S.F. BI L IT'i-I TCI I...'1EPARTHDIT DURP-4G THE. THI::5 PROPERTY AND THE OF MAY WELLS AD-TAF:ENT TCj NlJt-IBE-'R OF THAT T[ --IE WELL klILL �ER1,iE. "T...:5:: C-11 P-4 F-1 EE F-Rw E -HE G IF.' FEEC FINC, FIPPROVAL. BY THIS E: A C I FI L L. I hl G ("IF' AP. -h-1 WITI-IC'l-IT FINAL I p C-lEPAF`Tmf-,-'t-4T BE' SUBJECT TO PRO EI i-Ilt-11-VILIM F)ISTAt-4CE BETkIED-4 A 1-40-1. FIP-41:1 AtOr' Ohl --SITE SEIdAGE DISPO.5-AL IS 7 1 .1 :1.1210 FEET FC -F, Fi P RI I...' FITE I--IELL OR, lr�:O TO 20C., FEET F'P.01,1 FI PUBLIC". WELL C, E P E P. -I I.) I hl G UPON THE TLr:F,E' CIF PUBLIC WELL. I TF, I'l 1 ['11 IN C.-IS'TANCE, FF,Olvl A PRIl,/ATE WELL TO A PRI%,'A"I*F.'. :w -E l.-IER LI[ -,IE l: r', 225 FEET ANCI TC.1 A (" '01,11-lUtAITY 5EkIER LIhIE 1'..; 75 FEET. O"I'TIER, REGUIREMEhITS IlAli-' APDL.',.'. SPEi-IFIC:FITICINS i7jP-1D [iIAGR.AMS FIRE W.,T'l I I TO IhISL.IRE PRFIPER ItISTALLATIC"IP.J. "T... > F 7,, 1 B Ez- S Cm F." E:-- r-1 P" I E ERTIFY THAT J.: I AM P"AMILIAR WITH THE FOR SEkIERS AND FORTH F:i-1 THE OF AhIL"Jil"'IRAGE. 2: 1 WILL Ii%isTALL. THE IN ACC:ORClANCE 14I TI -1 THE C':0DES. m. THE:Ot-4-SITE MAY REG'!UIRE ENLARGEI-0,11, IF THE I MADERSTAf-AD 1"1111"r' F.*ESIDENCE L'-:; RE'lli'DDELED TO 111C.I. UDE Ill' --IRE THFIN -4 BET,PM011s. .5- 1 G N E` L ve-Cl U E MUNICIPALITY OF ANCHORAGE Department f Health and Environmenta Protection 825 Street, Anchorage, AK. 99501 264-4720 /v) HANDWRITTEN PERMIT Permit #�6_� l l WSLL AND/OR ON-SITE SEWER PERMIT Applicant:Mailing Address: J Location: Phone Number: Legal Description:�� Lot Size: Type of Soil Absorption ystem Is: Trench:_ Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Lr' Soil Rating(sq.ft/br) (/S-0 The Required Size of the Soil Absorption System Is: DEPTH - LENGTH J_S 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 for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(H6t-D� 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(Z) INSPECTIONS ARE REQUIRED # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feel 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 u 3 * * # 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 theAn-site sewer system may require enlargement if the X sidence is e d led to include more that bedrooms. �� �> Signed �__G� .z ni Issued by : A licant •��: _� �j Date... j SWP/024(1/81) SOILS LOG �= MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 —/ SOILS LOG — PERCOLATION TEST PERFORMED FOR: ay is .I�l,.> ^ DATE PERFORMED: LEGAL DESCRIPTION: l �7 '�-` •� �`\��``1� 2 w grcc� , 6VA (Uj-'e- ,, ro cpr�v�',tly .sc�� 3 - r, ,v f' �4 5 .�� qrC 11�Vtf 6/(��� �� try qrc 7 9 10 12 13 14 15 16 17 18 19 20 COMMENTS IM SLOPE I SITE PLAN elm '31 4iV qr� WAS GROUND WATER 1V� S 1 ENCOUNTERED? Iy L T O E IF YES, AT WHAT E DEPTH? _ Reading Date Gross Time Net Time Depth to Water 0 r. 13 «t,Iq 1al a /0 _ /3•-<l3 '5e qcF -} N2 c� SIC r� k� : S I •5 7 TL I "'XX I elm '31 4iV qr� WAS GROUND WATER 1V� S 1 ENCOUNTERED? Iy L T O E IF YES, AT WHAT E DEPTH? _ Reading Date Gross Time Net Time Depth to Water Net Drop +ilzc� I 13 «t,Iq 1al a /0 _ /3•-<l3 '5e qcF -} N2 c� k� : S I •5 7 PERCOLATION RATE (minutes/inch) TEST RU BETWEEN— FT AND ���-- FTr PERFORMED BY: CERTIFIED BZ wyor) 5� Cly 72-008 (6/79) DATE: C_) J(1-0 f 1 BILL SHEFFIELD, GOVERNOR i DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 274-2533 November 2, 1984 Alaska Enviornmental Control Services, Inc. 1200 W. 33rd Avenue, Suite B Anchorage, Alaska 99503 SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Sofr_y"Gk Subdivision, Lot 10 (8521 -WA -056) Dear Sir: The Department has reivewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 86 feet on the subject property for a single family residence only. BEE/msm 0 Sincerely, 4Buce E. Eric son District Engineer //- 1 -?v u;s®¢ Shry41�Sr�,�. AWU _ der OL I ®CPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 November 2, 1984 Alaska Enviornmental Control Services, Inc. 1200 W. 33rd Avenue, Suite B Anchorage, Alaska 99503 BILL SHEFFIELD, GOVERNOR 274-2533 MUNICIPALITY OF ANCHORAGE pEPr. OF HEALTH & ENVIRONMIENTAL PROTECTION NOV G i98i� SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Shryrock Subdivision, Le#—'�O (8521 -WA -056) 4,p3 Dear Sir: The Department has reivewed the subject waiver request and hereby waives the horizontal separation between the well and septic tank to 86 feet on the subject property for a single family residence only. Sincerely, 4Buc?-eef . Eric son District Engineer BEE/msm ALASKA NUIROWnTAL COnTROL SCnUICeS, InC. engineering & enuironmenlal Studies A,'UNI CIP,%,LITY o FNCHOKAGE November 5, 1984 I"UT O, HL«LTH & ENVIFO d!vl::: lTi,,L P;?OTLC71ON Mr. Robbie Robinson NOV Ig84 Department of Health & Environmental Protection �$ L 825 L. Street ' �A V Anchorage, Alaska 99501 Subject: Lot 3, Block 0 Shryrock Subdivision Dear Robbie: On August 1, 1983, Jim Roberts wrote a letter to Ms. Doris Davis reference Lot 10, Shryrock Subdivision. This was in error to a HAA. We became involved with it at 'that time. We have done soils tests, inspected upgrade, absorption field, septic tank, etc all under that legal description. Your office also issued a sewer permit, 830808 for lot 10, Shryrock Subdivision. Since that time, the lot has been carried by both us and your office as Lot 10, Block 0, Shryrock Subdivision. The legal description is wrong. The lot is a actually Lot 3, Block 0, Shryrock Subdivision. All paper work done since the original error was made has the wrong legal. Please convert all paperwork to reflect the proper legal, lot 3, block 0, Shryrock. Lot 10, Block 0, Shryrock does not exist. Sincerely, Ron Godden Environmental Engineer 1200 West 33rd Auenue, Suite B 9 Anchoraqe, Alaska 99503 a (907) 561-5040 J r PDC' c u�r �v� Th'Ar m hl /oy. E.3 y ° b WELL P P � � :26 six S7 -02Y iVO rr.�_f 0, 4i/,pii YL IGNr C_/J7- 6A? A, 6A?A, AG 6 - LI Lid SE/'TSG C `z YEN73 • C � • v o. SAS r /06.63 SURVEY TYPE !� ❑ AS- BUILT - NO CORNERS SET ❑ PLOT PLAN - AS -BUILT - LOT SURVEY -TOPOGRAPHY ❑ LOT SURVEY ® RECERTIFICATION AS -BUILT - NO CORNERS SET 33r a w 331 SYMBOLS �E ASSUMED ELEV. aw> DRAINAGE �-�-e- wDOD FENCE .4 Cc5MCN7- _R- CHAIN LINK FENCE. NOTE= Fences are shown in their approximate locations only. It isthe responsibility of the builder or owner, prior to to verify building grode relative LEGEND hub a tock -found ❑ set iron rebor -found O set • construction, proposed to finished grade and utility connections and to determine iron pipe -found O et 0 brass cap -found ® set the existence of any easements, covenants or restrictions which do not appear on the recorded subdivision plat. alum. cap -found a set Q Lot Survey Certification on® t �y�� OF A4�vYr. Prepar d by BENCH IWAfK INC. I hereby certify that I have surveyed the property shown described hereon, andLZ i7��; •°°noo°ro"^^s� aqui ``�° % •< professional Land Surveyors _® Drawn by: and the improvements situated o V g (45T� j. a`Zr (ash Scale= „ , 1 = 40 WAH Date Surveyed 1984 Oct. 8, Checked b y` REJ thereon within the property lines and do not overlap or �r ; "^ °^O ° Q; encroach on adjacent proper and that no improvements q�° ° Boc"B °o Op 0 Dote Drawn: Grid; W.O. odjaceMpropertyoverlapor / °°ROBERT OR R. Oct. 9, 1984 3034 84-280 encroach on the premises in �� 414) °° V question and Ihot there ore ��� °o °°°, e`b�G47' Legal Description: Lot 3 5111 yOCk $Ubd1V1S10n no roodways,utititylines o dti �pfj `°�°°°o ��Zj . other vis I ble easements on soid property exreptos ind C31+'10,f Parcel I.D. 018-252-09 Municipality of Anchorage A On -Site Water and Wastewater Program (907) 343-7904 . Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: / / — / / — I Complete legal description Shryock, Lot 3 Location (site address) 2946 Nugget Lane Anchorage, AK Current Property owner(s) U.S. Bank National Trustee Day phone Mailing address Real Estate Agent P.O. Box 8265 Wichita Falls, TX 76307 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: Individual Well F] Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Variance request for. Received by: v COSA to be released to Zengines. unless Day phone TYPE OF WASTEWATER DISPOSAL: Individual 0 Holding Tank ❑ Community ❑ Public Sewer ❑ by the engineer. COSA Fee $ °J Waiver Fee $ Date of Payment gi (01 15 J-"' Date of Payment Receipt Number d �G Receipt Number COSA# O�� St�tS Waiver# S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineers Printed Name Michael E. Anderson, P.E. 6. ATURE DSD System #1 Approved for —3—bedrooms System #2 Approved for bedrooms Disapproved Conditional approval for bedrooms, Date 8/5/2015 ® ��• OF 44 1140 o *; 49TH f 'r r A," MICHAM tPKKURSON : � X J : CE -4381 ®9+'SPF•• f �S� f�.•���� ®,®®�pROFESSIl1Na.p•►® with the following stipulatillAu-%ivvii By: di3Original Certificate Date: S — / I' /,7 The nl �O, evelopment Seryices Division (DSu) issues Certiricaies of Cn-Site Systems Approval (CvSA) based only upon the representaparagraph 5 by an independent professional civil engineer registered In the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet r :.i c If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Shryock, Lot 3 Parcel ID: 018-252-09 A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) N Date completed Pre 1973* Sanitary seal (Y/N) Y Wires properly protected (YIN) Y * Total depth 60 ft. Cased to 60*ft. Casing height (above ground) >12 in. FROM WELL LOG AT INSPECTION Date of test 7/17/15 „Static water level ft. 35.2 ft. Well production g,p,m. 3.0 9- p.m-WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate 18 mg/L Arsenic ND ug/L Date of sample: 5/29/15 Collected by: Anderson Engrg. *Information Taken from Municipal Files. B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed <1973/10/6/83* 600/1250 1/2* Tank size gal. Number of Compartments Cleanouts (Y/N) Y N** Foundation cleanout (YIN) _ Depression over tank (YIN) N High water alarm (Y/N) N Date of pumping 5/31/15 Pumper A Pius Home Services Two Septic Tanks On Site. 600 Gallon and 1,250 Gallon. **Clean Out in Crawlspace. C. ABSORPTION FIELD DATA Date installed 10/6/83 Soil rating (g.p.d./ft2 or ft2/bdrm) 150 SF/BDRM System type Deep Trench Length 78* ft. Width 5* ft. Gravel below pipe 2.5* ft. Total depth 10* ft. Eff. absorption area 936 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/17/15 Results (Pass/Fail) Pass For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 650 gal. New depth 12 in. Elapsed Time: 1,440 min. Final fluid depth 0 in. Absorption rate >= 600 g p d Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date *Information Taken from Municipal Files. D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm &-circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot $ 86 On adjacent lots >1 00 Absorption field on lot >100' On adjacent lots >100' Public sewer main >75 Public sewer manhole/cleanout >100 Sewer /septic service line >25' Holding tank >75' Animal containment areas >50' Manurelanimal excrete storage areas >100' SEPTIC/HOLDING TANK ON LOT TO: Building foundation >51 Property line >51 Absorption field >5 Water main >10' Water service line >10 Surface water >100 Wells on adjacent lots >100' ABSORPTION FIELD ON LOT TO: Property line >10 Building foundation >10 Water main >10 Water Service line > Surface water > Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS "Waiver Issued. G. ENGINEER'S CERTIFICATION14 m�E OF.A t i certify that t have determined through field inspections and ®Q�,"• 4.4 review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. e �'40- W Michael E,°�""° ... . Anderson, P.E."._ Engineer's Printed Name ,,,,,,,,;,,,,,,,,,,, Date 8/5/15 MICHArL E. AAN81ERSON COSA brown sheet 10-10-12.doc 0 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION,),, D / DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL, OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, towns iprange) �Ss¢,tY©C/e'�'..•�C'•,u,� Location (kddress or directions) (b) Applicant Name /f//Y - .. cAiP�i� Telephone: Home 3s�S-7GGS Business Applicant Address (c) Applicant is. (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution,'(/7AAnd Telephone Address (e) Real Estate Company and Agent 7&-1 6VAO-7 8/c honk/l Address Telephone 276 " 777LT (f) M 2. TYPE OF RESIDENCE Single -Family Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual WeIIU Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite{( Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,84) G 3 s/�[Iro ez . 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 this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm S Telephone /� Address 1,2."A) .33 rcl /�W- _ u iy- _,8lbtle4/ y �� 3 Date ®l,.►ulALewi 14 ""llit �••� •••��•di��.*fib DHEP APPROVAL Approved for bedrooms by Date Approved � / ' Disapproved Conditional Terms of Conditional Approval �� �i11�1►aTl' CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Pnge 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOAr MUNICIPALITY OF ANCHORAGIHEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL SERVICES DIVISION CHECKLIST- FEBRUARY 1984 284-4720 AUG 71907 Legal Description: 40`7-3 �z� /L3tJ ��G- 33 A. WELL DATAR���IV�D Well Classification _k/If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Ye—Date Completed RRC /973 Yield Total Depth (0/ 60 r C sed to V a A Depth of Grouting .JIA Static Water LevelPump Set At r Casing Height Above Ground — � Sanitary Seal on Casing) Electrical Wiring in Conduit (Y N) Depression Around Wellhead (Y� Separation Distances from Well: f / To Septic/Holding Tank on Lot ��' �� i� On Adjoining Lots O To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line A/1" To Nearest Public Sewer , Cleanout/Manhole I To Nearest Sewer Service Line on Lot 7, t Water Sample Collected by /�ereS A W/ErA) ; Date Water Sample Test Results SSS ) f'177F� 22 Comments® piez, cc.) 7z'sr 7-7-?- -x'7• nsaw !w'ehw Dtluw?,S RE?Ae7 Co B. SEPTIC/HOLDING TANK DATA PRE'/973 c Date Installed /0"(9-0 Size /moo No. of Compartments _ a Standpipes6N) Air -tight Caps) Foundation Cleanout (Ye Depression over Tank (Ye Date Last Pumped __ZA947 Pumping/Maintenance Contract on File (Y/N) ��%} ; for ,d/4 Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/'N) // /� — Separation Distances from Septic/Holding Tank: To Water -Supply Well �Z �� To Building Foundation / To broperty;Ljn, �S To Disposal Field r To Water Main/ Service Line /V 't To Stream, Pond, Lake, or Major Drainage Course Comments1 �k PSE /97,� A -4f . f S 71ih' Wd>ti!✓�,@� 1 . Page 1 of 2 72-026(11/84) 3 S/*,1eeK C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata %>U Type of System Design %jf'/0ic1Fj�GG� Date Installed /O'1o��3 Length of Field Width of Field Depth of Field Gravel Bed Thickness Square Feet of Absorption Area O 9 Standpipes PresentON) Depression over Field (Y® Date of Last Adequacy Test 7.. z -z -X7 Results of Last Adequacy Test vef-v — Separation Distance from Absorption Field: To Water -Supply Well /4< To Property Line To Building Foundations To Existing or Abandoned System on r On Adjoining Lots To Cutbank (if present) Lot 44AUI r To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course /_0 f To Driveway, Parking Area, or Vehicle Storage Area /e :e - Comments Comments D. LIFT STATION Date Ins - Size in Gallon "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhnla/Ar:r:P.CC !Y/Nl "Pump Off" Level at Vent(Y/N) �pings during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ha hec d, ve ified, or conformed to all �MOA and HAA guidelines in effect on the date of this inspection. Signed �l/ti e'�"" Date a 7-8l +'��� Company c`f MOA No. ®d'SF _ ,��..y°•"••.''Q� J Lam' ���' •' '• Receipt No./ d / pCr�;• _ �;��� Date of Payment lJ �%8110®0 0 '° •ei° Amount: $� o Y e. RED, 9R. � �) EJe �R/GGRS �Gdi'iRT °o . CE - 2251 Page 2 of 2 72-026 (viae) Ze A�rV j� A/19P✓N7l' l�x� /�d'P� HEMIC 5633 6 STREET ANChIORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 FEI7ERAL TAX ID li 92-0040440 A I" ili f RlToRT lly To; APC�; .4o I, "I"Plo AV), M ANCHINAGII, it -K, 99")V, ,T F I T) I JLJ: I L Chuillidb li! 0190 1 e; 0 flah.W WO;er 2 1 C, M9A1..Y'oj.3 fj j,AI,,l.lMTllP'Y S,[ IP14TV I SUNNI, C, MlI, oly, A UNot ll,�lnd I;Of k, ,, 1'. (llctl I 1 � I A 11 (woo 0 I it h, Ycc (I Jljl f1 , �1;,jY To; APC�; .4o I, "I"Plo AV), M ANCHINAGII, it -K, 99")V, ,T F I T) I JLJ: I L Chuillidb li! 0190 1 e; 0 flah.W WO;er 2 1 C, M9A1..Y'oj.3 fj j,AI,,l.lMTllP'Y S,[ IP14TV I SUNNI, C, MlI, oly, A UNot ll,�lnd I;Of k, ,, 1'. (llctl I 1 � I A 11 (woo 0 I it MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date '2 $ oa410 (a) Legal Descr.iFtion (include lot, block, subdivision, section, to Location (address � or directions) -- —Q�4 I J�IuGGET (b) Applicants Name 4L\)-jo pnJas Telephone - Ho_eyy A?30SBusiness Applicants Address oZGU(a1yuG66T LANe= 4ACkona6-6 41Z '799-l% e) (c) Applicant is (check one) Lending Institution ; Owner/-bcri-1-der ; Buyer ; Other (explain); T� (d) Lending Institution Telephone �- Address (e) Real Estate Co. & Agent IJJ; Wf_ -, Mc)KR`Csc=/+k i eD C4fz'Pr - �- Address c�9'CY9 Aac-�rL `J)W'te AO) �Y,CL'0 itSc��k �/g5'Q3 'Telephone 5('I- 55 Y (f) Mail the HAA to the following address: 2. Type of Residence Single -Family, Multi -Family Number of Bedrooms 3. [dater Supply Individual Edell � CommunityEl Other (describe Public = Note: If community well system, must have written confirmation from (:he State Department of Environmental Conservation attesting to the legality and status. G. Sewage Disposal Onsite Public Community Holding Tank r Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. [Page 1 of 21 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 this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is 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 in compliance with all Municipal and State codes, ordinances, and regula- tions in effect on the date of this inspection. Name of Firm Telephone%pi�S Address 12 C)( -)UJ 3 � �WC '4MQ Lt0/Z 4CrC- f'C Date__4e� Z 6. DHEP Approval Approved for Approved Terms of Conditional (ENGINEER SEAL) V, 4P % 461 Qg� � bedrooms B ' L Disapproved Conditional Approval CAUTION tF b ►0.�.�/0 .u:i.n 0 �a s��. <. .iraZr .• fi AA' x'.44 - THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP 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. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7--19-84 MUNICIPALITY OF M,!CHORAG;: DEPT. OF iJU,,[iiI MUNICIPALITY OF ANCHORAGE (MOA) LNv1PONMLNr:\L Ha_ -CTION HEALTH AUTHORITY APPROVAL (HAA) NOV 1984 CHECKLIST - FEBRUARY 1984 A. WELL DATA Legal Description: `SCJ 5ht?_!e -0ek Well Classification ;1ytp If A, B. or C, D.E.C. Approved(Y/N) Ai, Well Log Present (Y -WO Date Completed pve /G73 Yield �p,U'{ Total Depth GT I„o' Cased to �'o' ,4 Depth of Grouting Static Water Level 32,-2..b Pump Set At --�— - _ Casing Height Above Ground _1,_(4' Sanitary Seal on Casing ((jDI) -t� Electrical Wiring in Conduit (Y/N) *,y4 Depression Around tbllhead (Y N Separation Distances from Well: To Septic/Holding Tank on Lot 1A R�' ; On Adjoining Lots 6•r IOU' To Nearest Edge of Absorption Field on Lot flj,'Z' On Adjoining Lots_6-LL To Nearest Public Sewer Line N a To Nearest Public Sewer Cleancut/Manhole N4- To Nearest Sewer Service Line on Lot oj,�4- _ Water Sample Collected By Q_ G000erl Date.— Water Sample Test Results Commnts "— W1e,_P uopy2Grtca.tNO No W -Lee ¢bJJF avm"o 'iF,i- ?ve- 1913 B. SEPTIC/HOLDING TANK DATA Date Installed Xce"9� 1g83 Size 4 &000 1060 No. of Ccmpartments * 4 Standpipes QN) _W Air -tight Caps (Y/N) Fo ndation Cleanout (Y Depression over Tank (Y nZ Date Last Pumped / IL2 Pumping/Maintenance Contract on File (YM) N0,- ; for _V�_ Holding Tank High -Water Alarm (Y/N)pjl, Temporary Holding Tank Permit (Y/N)►V4- Separation Distances from Septic/H� Tank: To Water -Supply I RG To Building Foundation 1�! To Property Line c15 I To Disposal Field X-2 31 To Water Main/Service Line Ali To Stream, Pond, Lake, or Major Drainage Course &-i 1 UO, Comments ov rAtnL QyOem / - (Ap(ir?apry (b Fvuwi As_bNP f - Receipt #k Date Paid: Amount: 0.0 (Page 1of2] 2-•15-84 (T /(.) Sh24fCL)cK- C. ABSORPTION FIELD ARTA Soils Rating in Absorption Strata 15-0 Q'/6n-Type of System Design .-irZcs% Date Installed IV (0 "33 Length of Field Width of Field 3 6,0 Depth of Field Y G� Gravel Bed Thickness Ve3(jl/ Square Feet of Absorption Area &Uy CJ Standpipes Present 6/N) L/„es Depression over Field (Y/I9 rlam Date of Last Adequacy Test tv9- Results of Last Adequacy Test __ 4 - Separation Distance from Absorption. Field: To Water -Supply i,b11 IIC-, -L-, To Property Lire 1- I-] To Building Foundation * S� To Existing or Abandoned System on Lot UN Y, _ ; On Adjoining Lots (r/ iU U i To Water Main/Service Line N A- To Cutbank(if present) G T 2S To Stream/Pond/Lake/or Major Drainage Course G'1(G u/ To Driveway, Parking Area, or Vehicle Storage Area `4�t Continents D. LIFT STATION Date InstD I Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes( Comments Dimensions Manhole/Access (YM) "Pump Off" Level at Vent (Y/N) Pumping Cycles u Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verif_iedr or conformed to all MOA HAA Guidelines in effect on the date of this inspection,. Signed L�� � s Date `.LVSae W. Company /kECS MOA No. -02 �'�pENG4 KBl/d5/s ay C. Reid, Jr. No. 2251 •E _.- Vent : (Page 2 of 21 _"°,��,.�•°' �` i Sewer Disposal Individual Public Utility Year individual Installed: Holding 'rank When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. APPLW�NT FILLS OUT UPPER HA' ONLY Property Owner Phone Mailing Address CT S2 rBuyer Zip Code 7 Address Lending Institution Zip Code Phone Address ReallyZip Co. & Agent — — — — Code Phone Address Legal Description 9 Zip Code Street Location Type of sidence P"Single Family 0 Multiple Family No. of Bedrooms El Other TT Water Supply Individual ATTACH Community D Public Utility WELL LOG. A well log is required for all wells drilled since June 1975. Foorr wwells drilled prior to that date, give well depth (attach log if available). Sewer Disposal Individual Public Utility Year individual Installed: Holding 'rank When Connected to Public Utility: NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. August 1, 1983 JiOri , I?dvi.: it. Rt. %\ 1°'ox 11019 Anchorage, AK 99`107 3ubject.s Lot 1.0 Skyr.oc�k Subdivision Approval for the i.ndividua_l, set7o-r and water faci.l.itic!s cannot be grarateci until the following items ilc"ave been romp.letedl ° `file septic tank pur�rped with a receipt submitted to this department. `1'he total number of gsaliom; pumped needs tolx: on the receipt and verified by a registered erigineer as to the ac.:tual number of gallons pumped. This is tQ ver. ii y the tai"l.e Of i:.}le :9e}_)tic tank. ° Lxpose the ,_septic tank manhole to v(-,r;.l y its cxistence. ° 21le top of the well. casing ,hot.;ld be ,y)aled so that ii-- is water. tight. ° An adequacy test needs to be por_formed on the existing leaching area. t'hi s te;t trill determinc if the system is; adequate accor_cli.nq to Nat -L fitanc3arcls. A 11st:islh of pri.vat-.e firms performing the test is aracloseci. hi report necsdss to be submitted to this office for our review. The sstarldpi.t)e to the Sewer :system need caps ora them and stiarlClpipe8 raised. abovo ground. Please notify this Department for a rein:;pecti.on when the noted discrepancies have been corrected. If there are any further questions, please call this Office at 264-4720. Sincerely, Jira Roberts . stmciate Environmental -Sp('_cia-Ust: J;t6 B/p/E Pnclosure M . -,-<-H- 7U r' _ YQ ci.'d r Cbwr rnn n f rp 1-40-1 M a u7 r) >C:m ; m :...... n vii . �-1.1Kr - •,,� � � : �.� z 4M Li . • <)C]C�O m m z VJr' T� Q04� Z Vl4.0.Afljch Q 1.. W , .t A M m Z+ Ona 0 � h • n -4C ,,, ,.. Cirnl 4`A z Z N cca.. , fi %0CD, m 0 rn 'Ply :;tA . - - .,n N o� u coGO ►•' P x O fn to O �'. kArJN Z �4 Atil un ' Jam a, ti+11) 0` cp me c a9Qfn V'0 ° Rv 00 M 3'� x x6ry mm a p -Qwz ° m 0< 7m�c m 'p o77m o 070 1 n c T�o< o �00000 E 3 3 C o..0 -o-v3 o' z - oar m' or- ,tNm QmQ o o r < .3NN m^o'o0 HCl m a� o0 md�Z i '�zm m7�Z _. -iy c N o oM� 3 a v D p'p r n r�'om --1.i ,. p m Y E o Z �.2� 5, T a. mU, K f0 2 �.° o'� :� N O ° D M G)m m70 �oN-C 3 �i �mmi' "-dZ to o via ° °oo.°�°Nm rn Ay �{ m wnnr 3v0 n m = Nolo �vl ' E<°1= 3�m� 'mW mo -Em pv�oo p :n ° m 3 C A RI > y� ma aaoLi <"-tn �mZ m o yOv N a a (n N ° M W N m 0 S ° T K K m _. NrC'�J m o h n Em E O '0OO: °'o o 7°°°O agac m MO c mmo mxCL c ° 3m$ �N= Py _O S �'� o'ro Noary D E 3�n °- �cN nz 0 X351°.^. c m m =Nn D �r m r.,c m m to �l NNN•°O m i w< rc(I ALASKA C3WIROWnTAL COnTROL SRUS, InC. engineering & enuironmental Studies AUGUST 10 1983 DORIS DAVIS SRA BOX 4019 ANCHORAGE AK 99507 SELLER — DORIS DAVIS BUYER SUBDIVISION — SKYROCK BLOCK — 0 LOT — 10` ADEQUACY TEST FOR SEWER SYSTEM THE TYPE OF ABSORPTION SYSTEM IS A CRIB WITH AN UNKNOWN AREA. THE SYSTEM IS CAPABLE OF ACCEPTING 260 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 192 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 4 BEDROOMS. THE SEPTIC TANK WAS PUMPED ON 8/10/83 . SEPTIC TANK ADEQUACY DUE TO THE THICK SLUDGE ONLY 600 GALLONS COULD BE PUMPED OUT OF THE EXISTING SEPTIC TANK. THE SEPTIC TANK WILL HAVE TO BE VERIFIED AT TIME OF UPGRADE. ff O p"p,�•((//, ® aa qr,.�p� n �497M' l • 77 q u Leroy _. Reid, Jr. N 2251-E 1200 West 33rd Auenue, Suite 3 • Anchorage, Alaska 99503 9 (907) 276-1361 n i I I I 64A 84 B iII f m _ M M LANA_ --- _ NUGGET----- -_ M M EAST BASIS OF BEARING M 105.00-- r T \, FASc M: N7 n 2 3 I w A zo o J , II✓ o- //'�� L, r 31,201.OT r- 0 m^�I s4 ft. m 0 \ o cvl �N o \ J V1 4 U low�- - EASEMENT i L — 105.00` -- — WEST --- --- 2oxlo' S f /o, I � I� IISB 116*�it; I I I 33 200 100 0 n i I I I 64A 84 B iII f m _ M M LANA_ --- _ NUGGET----- -_ M M EAST BASIS OF BEARING M 105.00-- r T \, FASc M: N7 n 2 3 I w A zo o J , II✓ o- //'�� L, r 31,201.OT r- 0 m^�I s4 ft. m 0 \ o cvl �N o \ J V1 4 U low�- - EASEMENT i L — 105.00` -- — WEST --- --- 2oxlo' S f /o, I � I� IISB 116*�it; I I I 33