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HomeMy WebLinkAboutSOUTHFORK NORTH BLK 2 LT 4South Fork North Block 2 Lot 4 #078-141-14 Municipality of Anchorage Page ( of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 4 2.0075 PID Number: e78— I L41 - I q Name: VOR Wastewater System: ❑ New ❑ Upgrade Address —7 3 / ABSORPTION FIELD Phone: No. of Bedrooms: ❑ Deep Trench CKShallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating:Total 6 Depth from origi al rade: o GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe Sod O Ft. Ft. Township: Range: Section: Fill added above original grade: Gravel length: 3.5- Ft. 50 'f" 6LI Ft. New ❑ Upgrade WELL•• El� Gravel depth: cal+•ti Number of lines: Distance between lines: 1 TJ' Ft. 2 1 'o Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: Ft. Ft. u 0 SO. Ft. F 910 -6C134 Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. T l -i o q V__ 47. Z L$ - 4. 30 - 1 Y 9 7— Yield: Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ❑ Septic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer Lines Well I�la1 O� l Q % it Upv — �— _ Material: Number of Compartments: g5 LIFT STATION Water Lot - Size in gallons: Manufacturer: Line too) 3 0 Foundation- n r) "Pump on" level at: "Pump off' level at: High water alarm at: Curtain Pump Make & Model Electrical Inspections performed by: Drain Remarks: BENCH MARK C21 LA Location and Description: �^ I r Lowe S, b r f-" La, JM�- QaAA Assumed Elevation: v y lei tj ENGINEER'S SEAL ' IS Inspections performed by: Dates: 1st_ 2nd iv• l� �'2?,,, �:�., oD oa, . a.:.., Department of Healt=aq a Servi es approval Reviewed and approved by: � Date: 72-013 (1/91) MOA 25 J36 \ 53.5 \ \ \ 723 \ \ \ \ \ \ \5P5242 \ \ \1354 \\ \63.5 \ 25 7,75 50 75 100 125 150 SCALE, I' = 50 FT, TOBBEN SPURKLAND P.E. LOT 4 BLOCK P SOUTH FORK NORTH SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE SECTION 9 T13N RIV DATE, OCT, 8 1992 ANCH. AK. 99501 BOB VORIS SHEET! 2/3 GRID! SW959 /VU JI.HLL limen .nc, 97 64 TOBBEN SPURKLAND P.E.SEPTIC SYSTEM ASBUILT 203 W15th Ave LOT 4 BLACK � SOUTHFORK NORTH Anchorage Ak 99501 SECTION 4 T13N RIW DATE OCT, 8, 1992 BOB VORIS 11 SHEET: 3/3 GRID, SW95 PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE 1 3C ei rn DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920075 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:VORIS ROBERT A & ESTES-VORIS OWNER ADDRESS: PO BOX 771361 EAGLE RIVER, AK 99577 PARCEL ID:07814114 LEGAL DESCRIPTION: SOUTHFORK NORTH BLK LOT SIZE: 61399 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 2 LT 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 5/07/92 EXPIRATION DATE: 5/07/93 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: THIS DRAINFIELD MUST BE INSTALLED IN ACCORDANCE WITH THE APPROVED ENGINEER'S DESIGN MODIFI D ON 5/7/92. THE TOTAL DEPTH OF THE DRAINFTELD MUST NOTI$XCEED 4.0 FEET. RECEIVED BY: ISSUED BY: DATE: DATE 0771�?Z_ waw v m P 0-.::z �-::_ N. 20 W 15th. Avenue, Suite D6 HCHDRAH. ALASKA 99501 (907) 2719-3916 SEPTIC SYSTEM DESIGN L.OT 44 BEOCK 2 SOUTH VO RK NORTH BOB VORIS lar c-iumd W,7atcm- I C) . 5 dr t t.jsc.-Y 4'Jlicje 'T'ref-Ic-h F -can April 1.992 Rat-J.11g. r 1:1,4 fnirill:iri = .3 qal/:�ci +t da,/ Arfeaa pc!r Bc:m:Jrocim- -ld 3t..(J"'acc.) a.t.1 1 cr.3 4 Qj I r .1- 3 12 -f t. I .... fmw;s 6 I t: c;rt I <k'tear- 7 IQ :-j - Beml oo l l� r) cl t I -I r-c�i chlool t C wys-r NVIGURAYION WIDE TRENCH TOTAL LENGTH 2 @ 40 FT = 80 FT. TOTAL WIDTH TOTAL DEPTH 5 15.5 FT_ FT. X/ Z9 RUCK DEPTH 2.5 . FT - — COVER 3 FT. SEPTIC TANK EXISTING 1000 SAL 1--ol... 4 2 F.-ork- 1'4c:}r--Lh Leave existing trenches intact, Install diversion valve for annual switching between existing trenches and proposed new trenches. The installation of this sepLic system will not Prevent wells from be ins�alled on the a6jacenL lots. There are no d(..!veloped or natural surface / sub surface drainage courses on this or the adjacent lots" The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from thJ.s installation. The Municipal Ground Water Monitor well located on South River Road, approximately 200 feet to the south of this lot has been monitored since 1985. Water levels has been recorded from 18 feet below ground level ( 910107) to 2 feet below (850816) with most reading being from 3 to 5 feet below surface. On April 21, 1992 the water level in this well was measured at 1 foot , more or less, below ground" At the same time 15 inches of water was measured in the GWMT installed on lot 4" This GWMT is a total of 12 feet deep. This observation indicates that the M<municipal well is not representative of the general ground water regime in the area. Septic System Design Lot 4 Block 2 South Fork North • Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: BrJ� oy– g DATE PER FORM ED`_^ - W I�J L LEGAL DESCRIPTION: Iz SOV it, 1..41, Township, Range, Section: j 13N. l uJ. _ 4 �� SLOPE SITE VLAN 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 d2.G�ry rGS d -- MS WAS GROUND WATER ENCOUNTERED? �t//b S IF YES, AT WHAT L O M C4DEPTH? p ,?>p Depth to Water After r 12. Monitoring? 10 gate: rl PERCOLATION RATE (� (minutes/inch) PERC HOLE DIAMETER �T�EST RUN BET EEN r 42- FT AND J— FT .q. COMMENTS ILA u- L&'+ '"w�/J i PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:Z- 72-008 (Rev. 4/85) • pPhtlo Water.. 4P rl PERCOLATION RATE (� (minutes/inch) PERC HOLE DIAMETER �T�EST RUN BET EEN r 42- FT AND J— FT .q. COMMENTS ILA u- L&'+ '"w�/J i PERFORMED BY: CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE:Z- 72-008 (Rev. 4/85) TO EXISTING TRENCHES m o Monitor Clean Ou]L Clean Out Wide Trenches,, 5' Wide 40' Long 5 5' Deep 2' Sewer rock 3' Cover 10 O Monitor Clean Out Clean Out 5 NO SCALE Cleanouts T4' Topsoil 11---3' Cover Mira -F; 140 1 1 1000 gal Septic tank EXISTING Monitor - Exist, Ground 4' Min Co ver overrank 24 in of Sep tic Rock 1000 gal, septic tar{ EXISTING NO SCALE TOBBEN SPURKLAND P.E. LOT 4 BLOCK 2 SOUTHFORK NORTH SEPTIC SYSTEM DESIGN 203 W15th Ave11 SECTION 4 T13N R1 k/ DATE- APRIL 22, 1992 Anchorage Ak 99501 BOB VORIS SHEET- 313 GRID, EV95 SPECIFICATION GUIDE SI01111•il•1'A1.1'E DIVERTER VALVE Dlverler Shield Cap— NOS-6006 Diverter Shield Diverter Valve Stem and Cap' Distributor Box Outlet Cap ' NDS -400 6 ABS DIVERTER VALVE Plastic diverter valve designed for septic tank leach fields, Irrigation and other applications. Molded In ABS plastic. Valve stems available for three-way flow, or 1800 two-way or 900 two-way flow. To install, connect standard 4" plastic sewer and drain couplings or regular reducer fittings to inlet and outlets on the four-way distributor box. (Unwanted outlets may be sealed by installing outlet caps.) Cut diverter shield to desired depth and install in top sleeve of distributor box. Insert diverter valve stem. Cover wish diverter shieldPOSITIVE CONTROL cap. To divert flow, just grasp handle and turn valve stem. olc� Arrows show Ilow pattern. To permit flow from all outlets, just remove valve stem from assembly. r SEE OTHER SIDE FOR APPLICATIONS AND DIMENSIONS IN o •I (t � r5o O .•: T ea„aB on a^e.- � s (7� ' f� 'r o ecec�age<�s9oe� 9 \ / �0; Tubben Sr.ri(i,'ad �i A II UbBLN JYUKKLAND F'.L. I I LOT 4 BLOCK P SOUTH FORK NORTHI I SEPTIC SYSTEM DESIGN I 203 W 15TH. AVENUE DATE APRIL 22, 199P ANCH. AK. 99501 SECTION 4 T13N RIW M75 279-3916 BOB VORIS SHEET, 2/3 GRID, SV959 j OM 250 300 50 0 50 100 150 SCALE+ 1' = 100 FT, V i T3 \ i i u \ \ 1 Well \ \ \ \ \ Well \ \ LOT 4 \ \ \ �( \ \V LOT 5 \ \ \ VACANT \ \ LOT IL \ LOT 6 Ip MUNICIPAL GROUND WATER MONITOR WELL TOBBEN SPURKLAND P.E. LOT 4 BLOCK 2 SOUTHFORK NORTH SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE SEC 4 T13N RIV DATE, APRIL 22, 1992 ANCH. AK. 99501 BOB V17RIS SHEET] 113 GRID, SW9j •03co00co00cow03com00w00co000:) comm coco00 0:)w0:)co03 co co coaowmoo ' wwwwwwwwwJJ�lJ'l�lm rnm01O\Ornm mmcnUlUl, Ul UlUlUlUlUIUl 0 0 0 0 0 0 0 0 0 H H H H O o H O o o O O o o - O O H o 0 0 . 000000 W 10 l0 10 w ON m m m NH O O W W N co w co W. Ol 0� m H HH w co. co m Ul Ul .P .P W W H O O N N H O O O N O 0 0 0 0 N NH H N N H NH H N H H H W N W N N H O\m 11 W �P Ulm U) -j Ul 10< P W H wH�P H Ul W 10 H-l1'Ph H 10 UI NoO010 0 I I I I I I O UI O O O O I I I FlJ UI O N O �OOOOUIO UIOOOF-��100Fi O OONOOHIO OOOOIO O 00 W 000 I I I I I I I I H H I ,p N N 61 O H 1 w I I I H W .P N 00 W 00011100000<-,100-WHOO4�1000NO00 100000 O OOOHOO) I I Ul I ¢ I I J d> Fi H H I 10 FC 00M00000-1100-11000100000 I I I I H to w N H H I I O m O O O lP O O O f N O O lP O O 10 O< O O O.P IO oo.P OOIOI:>o o, H H I I I I Ut D O O O O O O O O O H 00 I I I .•I 11`000000000 W �j 00 u A I I O O 010000 W OO I 01000 I W J 0 0 0 000 O IO 000Ul 0 10 OI Ul H 10 D O D O H O O D N O Ol O O O I II 61 Ul I Ul I V 1N ON l0 O O O o 0 0 0 N O 0 0 0 N 0 0 0 0 o w o I H I I I H H H 11 I H H H w .P w .P w lP Ul rn o�w rna to O w o o o o m l w O o o o N N O O o W 000 O IO 000Ul 0 10 OI Ul H 10 D O D O H O O D N O Ol O O O I I w l0 I cn V 1N � l0 O DOOOOMOOOMOOOOO C ` 0000000 I I I I a In P 000OOOUIO-I1 FY` I H 1 w l0 W ulow000000 1N � 1 I00 � Vi coo t 1N � x- =0 H O w w s-. a (D (D H- H �j N Ho (t (D r- (D X m m 10 K a�j m �C O N (D (D (D ¢ �jw rt m w (D Gm K K (D w P• (D H K tJ (D �C ct C (D H N- N- rn � (D (D H (D H Cr r- b In (D H i -b O K £ O N Q (D K O K m K M w 0 (D o[ MI ON"- C P V 31Of O O O 0 0 0 I a 10 O O W21 W ' H .P )tjo0k.0com000000c ) 0 0 0 0l0 l0 �D 101 ) O O O H H O O O C l W W W N N J �l v N H O O O H H O C ' O P to -1 IP co O "1 C O O C O O o 0 o c I I N H I ) W 0 0 0 m O Cb O ) )000 Fl L d�-0ld( 3 C 1 <iZ•Z•Z•7 a]Z•Z•Z•7 MI KRI D • > I I O + I 0000,3000 00 nAlar-Ji. Municipality o Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 September 15, 1992 Tobben Spurkland, P. E. 203 West 15th Avenue #206 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 4 Block 2 Southfork North S/D Waiver Request #WR920048, PID #078-141-14, SW920075 Dear Mr. Spurkland: A Your request for a waiver(s) of the required 100 foot horizontal separation of a septic system to the surface water has been approved. The approved separation distance(s) are 60 feet from the absorption field to the surface water. This waiver approval applies to the existing septic system to surface water separation only. Any future upgrade to the septic system will require all separation distances be met or another approval from this department. Should the operation of the subject wastewater disposal system cause any contamination or degradation of the subject surface water, this waiver will become void. Since�ely, Robert W. Robinson Civil Engineer On-site Services ljm:#5 Concur: / .1 ,4 hn Smith, P.E. rogram✓Manager On-site Services MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR# i,-r,11Qrl-,il4, PID# 078-141-14 HA# Permit # SW920075 Date Received: August 27, 1992 Legal Description: Lot 4 Block 2 Southfork North Subdivision Engineer: Tobben Spurkland, P. E. 203 West 15th Avenue #206, Anchorage, Alaska 99501 Applicant: Robert A. Voris Waiver Requested: absorption field to surface water 60 feet Criteria: 1. Geology: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAL: 2. Special Conditions: 3. Other: Waiver is Granted: x Points: Waiver is NOT Granted: Rec #: 23990/3681 Amount: $590.00 Date Paid: August 27, 1992 , � « l✓ / a 24 t///%�%NnS L--�s -) C\'\J 7F- SET T" U 140 Ov R. -A XI 13 F", - K~ 6751N.0MIONDBLVD. ANCHURAG['ALASKA, 995$2~3Y04 (907) 240-5095 Phi nicipality of August 27, 1992 Division of Environmental Health Department of Health and Socj.al Services 820 I Street Anchorage; Alaska 99501 ~^^ cn » Subject: Permit for Septic System Upgrade « ro rm Lot 4 Block 2 South Fork North SW920O75 ()enIr- leFri enrw ; A septic system permit for this property was issued on M�� 7� 1992. The design of the septic system was based on soil tests and ground water monitoring performed prior to breakup. Break-up and post break~ -up monitoring has shown that for In, substantial period of t[me the ground water level is between 4 and 5 feet below Lite surface. Several springs were also -Fouund� all but one stopped flowing after break~up. Based on these observation a distances has been prepared We ask for a granting of the revised design. waiver for surface water separation and the design of the system revised. ' requested waiver and approval of the 6751N.U[MONDBLVD. ANCHU8AG[IALASXA99502~3904 (907) 249-5095 Municipality of Anchorage Division of Environmental Health Department of Health and Social Services 820 I Street Anchorage' Alaska 99501 Subject: Waiver Request Septic System to Surface Waters Lot 4I Block 2 South Fork North Gentlemen; August 27' 1992 We are submitting a request for waivers from the separation dis- tances stated in Title 18, A}aslow. Administrative Code� Chapter 80.020" During field survey for to septic system up�grade it was discov- ered that a spring is flowing continuously along the north~west property line. The proposed absorption field is located approximately 60 feet from the spring and at a slightly higher elevation. The flow path fromthe drainfield is such that any overflow, or surfacing, of untreated sewage will flow in excess of 100 feet before joining the surface water from the spring. Moving the absorption field uphill from the spring will shorten this distance and increase the potential for contamination^ Yours Tobbe� S�urkland P.E. E: Am, r p, OAPAGE, SEPTIC SYSTEM DESIGN E- 0 T 4 0 E 0 C 1C 2 S Ow UP -1 mH �F 0 R K NORTH BOB vopis L4,?': 27, (,Jichn 'M c I la-A/scl 'c' J, ul"r ou f d k a r J. iD I h J. e 't d (n 1::-,, c:--. c; 1: "3 (-,z cl c; c in i::; T!; L 'c" SYST EN CONF= I SURAT 1— ON WIDE TRENCH TOTAL LENGTH 22 @ 57 FT 114 FT. TOTAL WIDTH 5 FT. TOTAL DEPTH I FT - ROCK DEPTH 0-5 FT. 0.5 FT - COVER 3 FT. SEPTIC TANK EXISTING 1000 GAL ABANDON EXISTING TRENCHES 1 ot I. 5cm-kth The installation of this septJ.c system wnot prevent wells from be installed on the adjacent lots. There are natural surface / sub surface drainage courses on this and the adjacent lots. Several springs are flowing continuously all year. Waiver has been applied for. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this ins�allation^ co Muncipal Ground Water Monitor well located on South River 200 feet to the south of this lot has been Road, approximately monitored since 1985. Water levels has been recorded from 181 feet below ground level ( 910107> to 2 feet below (850816> with most reading being from 3 to 5 feet below surface. On April 21, 1992 the water level in this well was measured at 1 foot , more or less, below ground. At the same time 15 inches of water was measured in �he GWMT installed on lot 4. This GWMT is a total of 12 feet deep. Septic System Design Lot A. Block 2 South Fork North �`Op0 0 96.� r \ e \ 5 q0 \ X2.1' \ \ F 82.6 90.( \ \ \ \ 73.7 \\ X76. \ 1.1v �'OAp \ \ op \2 \ \ Drainftel 25 0 25 50 75 100 125 150 SCALE 1' = 50 FT, REVISED AUGUST 27 1992 TOBBEN SPURKLAND P.E. I I LOT 4 BLOCK 2 SOUTH FORK NORTH I I SEPTIC SYSTEM DESIGN 203 W 15TH, AVENUE DATE, APRIL 22, 1992 ANCH, -AK.-.99501 SECTION 4 T13N RIW BOB VORIS SHEET 213 GRID SW959 57 o Monitor Clean Out Clean Out Wide Trenches: 5' Wide 57' L ong 5 1' Deep 1' Sewer rock 3' Cover 10 1000 gal Septic tank EXISTING DIVER TER VAL VE A O Monitor Clean Out Clean Out NO SCALE E" l Mira- i 140 )und 12 in of' Septic Rock' 1004 gal, septic tank EXISTING NO SCALE REVISED: AUGUST 27 1992 TOBBEN SPURKLAND P.E, LOT 4 BLOCK 2 SOUTHFORK NORTH SEPTIC SYSTEM DESIGN 203 WISth Ave SECTION 4 T13N RN DATE APRIL 22 1992 Anchorage Ak 99501 RnR vnwr , SHEET, 313 GRID- SW95 MUNICIPALITY OF ANCHORAGE i r r ' 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 ' kEW 1J��1 �—J i`� S� IwC> l (�• 2� �G ❑ UPGRADE MAILING, DRESS LEGAL DESCRIPTION / &K. 4 File.,e LOCATION NO. OF BEDROOMS DISTANCE TO: W J / �� ,7i- Absorption a ea Dwelling ` _ `0 "f PERMIT N U / _Y I ­_ Q Manufacturer yy C Mateja� J No. of compartments rn Liq c5aet gallons CC11 IF HOMEMADE: Inside length . Width - Liquid depth t®� D Y DISTANCE TO: Well Dwelling PERMIT NO. =Oz z Fa„ Manufacturer Material Liquid capacity in gallons DISTANCE TO: Well ©� / Foundation /� �© Nearest lot li,p�e /' PERMI�,I�. �f (j = s J t.J 17 Lu U ..a Z No. of lines Len th o ea h in g �l Total le h of fines Trench wid Distance between lines i F- W Z _ Ci r inches F Top of the to finish grade Material beneath tile 21* inches Total effective abs rptiQl;(.area t� -``�� ✓/ Length Width D th PERMIT NO. Lu Q F Type of crib Crib diameter r'b depth Total effective absorption area wa y Well Building foundation DISTANCE TO: Nearest lot line _j Class Depth Driller Distance to lot line PERMIT NO. —I W 3: DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER PIPE MATERIALS - P VIC SOI L TESTG ATIN% �iR/ /z , INSTALLER ✓J s14/I/,57 /0'1167-7e7k_! I REMARKS t-�7— - /puti/Y�./�f0 fit ff%flf i, /14�'��� *L ,Nr ��( ° j 4 •• 4 Z, ro 12 • MU DEPT. OF HEA1 1457-8.• :� VU Ijul APPROVED V r- A -.E DATE LEGAL GRED 19OX RIVER, ALASKA 72-013 (Rev. 3/78) --- _.__----------- - - / / I,--, ISI r rpt e:_ei'-A Y f I F_l L.._ I -r*? r_� F=" - F; -e t=l C3E DEPARTMENT `,--n` HEALTH AND ENVIRONMENTAL`-�-F:OTECTION 825 L STREET, ANCHORAGE, AK _ 9501 264-4720 I Tim :E; FE E= F 'PERMIT NO: _ 840297 DATE ISSUED:__ 05/07/84 APPLICANT: C/O , &- S ENG'G. DEAN CONSTRUCTION -ADDRESS :. _ SRB 9.9r_'.: . EAGLE RIVER, AK77 �v5: r CONTACT :PHONE 694-297_. LEGAL` DESCR'I P : SUBDIVISION: -SOUTH FORS! ` NORTH LOT: SECTION: 4 TOWNSHIP: 13N RANGE LOT SIZE` 61999 (SQ. FT.-- OR ACRES) ) r MAX`BEDROOMS: 3 F'F=14 M I T 4 BLOCK: 2 1W LISTED -BELOW ARE THE OPTIONS` AVAILABLE TO YOU IN DESIGNING YOUR SEPTIC: j SYSTEM. CHOOSE THE`"COPT I Ofid THAT BEST FIT' YOUR SITE. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ T % 1E 1'tit A=-1 1= E: C -A . t4- E -7v F? F:N I {°9 CSEPTH ..TO_. PIPE BOTTOr*t (FT. . 4: 0 4. 0 3. 0 GRAVEL DEPTH ,{FT. 2.0 0.5 W G TOTAL EPTH--<FT. } ..,.. 6.0 4.5 5.0 GRA`•r'EL�'WJDTH ` "f FT• } . 2_5 19 0 5.0 !GRA�r'EL LENGTHc.FT _.T _ 110. 0 *h: 35.0 €,2. GRAVEL `VOLUME ' ( CU. YDS. ) _ 25.4 24.6 28.7 • TANK SIZE (GALS) 10000. 0 1, 000.0 a.w. 1..000.0 + � . ►jIL: `f iTING.. c: St . FT. 'r'Bt }, . 146. 146 146 DEPTH TO _PIPE BOTTOM < 3.5 FT. REQUIRES INSULATION *-: -DEPTH TO PIPE BOTTOM < 4.0 FT. MAY REQUIRE A'" LIFT STATION GRAVEL LENGTH r 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH) TANK MUST HAVE AT LEAST --TWO COMPARTMENTS _I ­CERTIFY THAT: 1: I AM FAMILIAR WITH THE 'REQUIREMENT_ FOR ON—SITE SEWERS AND WELLS AS SET FORTH BY 'THE -MUNICIPALITY OF ANCHORAGE ( MOA) AND THE STATE C 1F ALASKA. ` 1" WILL `INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATION=, AND I -N --COMPLIANCE WITH THE DESIGN CRITERIAOF THIS PERMIT. :.--J-WILL ADHERE TO ALL MOA AND STATE ,OF ALASKA REQUIREMENTS FOR THE SET BACK DISTANCES' FROM ANY EXISTING WELL, WASTEWATER DISPOSAL. SYSTEM OR PUBLIC SEWERAGE SYSTEMON THIS OR ANY ADJACENT OR NEARBY LOT. 4: 1 UNDERSTAND THAT THIS PERMIT I S . `1AL I D FOR A MAXIMUM OF 3 BEDROOMS ANC}._. .ANY ENLARGENENT WILL REQUIRE AN ADDITIONAL PERMIT. IF A LIFT STATION 15 INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN f*1 } AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED C 2 AS—BUILT= WILL NOT BE APPROVED "WITHOUT AN ELECTRICAL INSPECTION REPORT: AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNEDDATE APPLICANT. C�'O' ,�:`c, tdG G: C~EAN. Cr_i _TRUCTIOFJ ISSUED BY �- (S t t�zt L DATE: 5 7 / 8� SOILS LOG MUNICIPALITY OF ANCHORAGE 1/ DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION El PERCOLATION • "l TEST 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: L e -AAI "Ay LST LEGAL DESCRIPTION:�L�LL DEPTH 2- 3 5 / 6- 7- 8 10 _. a SLOPE DATE PERFORMED: M,®j'eia Z.31 J90 SITE PLAN' WAS GROUND WATER 1 b 11 ENCOUNTERED? IIVV L O P 12 IF YES, AT WHAT E �0� �F 7 - 13 FF�� r -r DEPTH? 14 15 OF 17 yip, f4 ym . YQ 9n nF1®VBQPCn_y 4'.:S 18 ®oc Q' RUsseIl L 19 �� in.'x Pio- 42 Reading Date Gross _ Net - Depth to Net - Time Time Water Drop ae b® % OoeOcO a 90 ? 1 �5 O751er e q av 20 FES I PERCOLATION RATE_ TEST RUN BETWEEN MMENTS 4)4O,4c Or�Uj(�ly�/�/��% I Trt L. -r 1) 0,1 /L a L J -An! ('Ad% PERFORMED BY: /G 1145: 72-003 (6/79) - CERTIFIED BY: F- - (minutes/inch) AND FT DATE: ✓/r 6z by K [DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 • TELEPHONE 688-2759 r OWNER OF LAND i«1 :a.:> DEPTH OF WELL ADDRESS r STATIC LEVEL OF WATER FT. _ `'"- ry- " '� il LEGAL DESCRIPTION ' ` 1 `/` 7't 1r �IAW DOWN FT. DATE -Started > i-, Ended r% _` GALS. PER HR PERMIT NUMBER KIND OF FORMATION: From Ft. to 1 Ft. to a Ft. i "- From From Ft. to -2 -2 --Ft. Ft. From From 7 Ft. to_LL, Ft. r't ; .. _ ` f .,, - •, From Ft. to Ft. to Ft. Ft. to From }"Y Ft. to--:—,-Ft.r : From F Ft. to F_ Ft. .' ems'/ %-, _e,' f /-7 From—Ft. to 4/1 Ft. PON, From -t. , Ft. to_�_F o From Ft. to,7.t�� Ft. to Ft. From Ft. to Ft. to__: rt From Ft. to f Ft JX) r, s 11 ,i From Ft. Ft. to Ft. ¢; f f %�•.. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. MISCL. INFORMATION: KIND OF CASING f0 �v,` r( From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to Ft From Ft. to Ft From Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. to— oFromFt. From—Ft. to 4/1 Ft. PON, From -t. , Ft. to_�_F o From Ft. to,7.t�� From - Ft. to icy o 0 d(J�A�rl From - Ft. to Ft. From Ft. to Ft. From Ft. to Ft. From Ft. DRILLER'S NAME Municipality of Anchorage • • G E 6, On-Site Water and Wastewater Program (907) 343-7904 oil I CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel I.D. 078-141-14 Expiration Date: O "23 '. I E 1. GENERAL INFORMATION Complete legal description Southfork North Block 2 Lot 4 Location (site address) 2021 South River Dr, Eagle River, AK Current Property owner(s) Rhodes Day phone 865-6472 Mailing address same Real Estate Agent KW Day phone 854-2149 6 ' ,b _. r‘t 2. TYPE OF DWELLING: ,f"�'/i► ® Single Family (w/wo ADU) a � ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) wr'^ 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class C Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Received by: Date: -67/e.;///- COSA to be released to the engineer,unless otherwise requested by the engineer. COSA Fee $ O Ji&it& Date: Date of Payment 5 Date of Payment Receipt Number 2q(aD Receipt Number COSA# 6f)CJ I -O " Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of 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 NorthRim Engineering Phone 694-7028 Address PO Box 770724,Eagle River Engineer's Printed Name Steve Eng Date 511512018._ L 1' a or j 6. DSD SIGNATURE .; ••�'•,° 4) ... � 76 System #1 Approved for bedrooms. 5:�..,; �n• ' System #2 Approved for bedrooms. `a ;; : . /�s1(,.•,., Disapproved. ! ` =y Conditional approval for bedrooms, with the following stipulations: a�5 S,Ilric �; k i� 3 q . ., 2Lb iik NerP t cr6 a S S4 c Li 2n V' CML 0t1-g1TE Q. s v\INTER AND z \NASTE�NATER G `- ' pROCRp.Ni Original Certificate Date: S ' 2 3-itg The Municipality of Anchorage Devlopment Services Division(DSD)Issues Certificates of On-Site Systems Approval(COSA)based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska.The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: j ,•: . C COSA Checklist X Nitrate Advisor? ' Septic System Advisory Arsenic•Adii$ory„ Well Flow Advisory COSA blue sheet_9.1-12.doc )'? 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: Zoo-41-R el- /VO4-1-4. 6 Z L 4/ Parcel ID: O78 la ( lie A. WELL DATA Well type /p If A, B, or C provide PWSID# Well Log (Y/N) y Date completed SAN Sanitary seal (YIN) Y Wires properly protected (Y/N) 6ft. Casingheight(above ground) / in. Total depth 6� ft. Cased to 1 g FROM WELL LOG AT INSPECTION Date of test. 5/4' ii/z! h e Static water level /Z ft. Zt'J� ft. Well production 3 0 g.p.m. o g.p.m. WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate 0. 3'mg/L Arsenic 0• 3 ug/L Date of sample: l///y// Collected by: N/2,,,, B. SEPTIC/HOLDING TANK DATA Tank Type/Material . E'/°77 c/ S TELL Date installed //dc/ Tank size /0OO gal. Number of Compartments Z Cleanouts(Y/N) Foundation cleanout(Y/N) iy Depression over tank(Y/N) Al High water alarm (Y/N) /V Date of pumping 6/3(17 Pumper T-R C. ABSORPTION FIELD DATA st+q(iaw Date installed /6/Q2- Soil rating (g!ft2 or ft2/bdrm) 0. CIp System type j ceAct4 Length //!_/ ft. Width S ft. Gravel below pipe -s ft. Total depth . f ft* Eff. absorption area -5 70 ft2 Monitoring tube y Depression over field Ai Date of adequacy test #20 e Results (Pass/Fail) P For 3 bedrooms Fluid depth in absorption field before test 6 in. Water added 4/SG gal. New depth I( in. Elapsed Time: C 0 min. Final fluid depth 0 in. Absorption rate >_ 1(-SQ g.p.d. Any rejuvenation treatment(past 12 mo.) (Y/N &type) (24) (G If yes, give date D. LIFT STATION Af/ 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 /Q0 `t On adjacent lots /0 O 1'f" Absorption field on lot /OG 17- On adjacent lots /0 0 Lf- Public fiPublic sewer main /D D 'f Public sewer manhole/cleanout /O G -4— � Sewer/septic service line Z 5 i" Holding tank /D G rt' Animal containment areas S 6 r Manure/animal excrete storage areas /TG f SEPTIC/HOLDING TANK ON LOT TO: Building foundation /O it Property line /D - Absorption field 5 "- Water main tf Water service line /O f Surface water �S / Wells on adjacent lots /OO (4— ABSORPTION FIELD ON LOT TO: Property line /6 Building foundation /Q f Water main (G rt I, r » Water Service line /6 -I- Surface water 70 -1Driveway, parking/vehicle storage /D .4 Curtain drain /Mire- Wells on adjacent lots /Do Cl"" F. COMMENTS it 44M Wrvv.6e G. ENGINEER'S CERTIFICATION • I certify that I have determined through field inspections and review of Municipal records that the above systems are in r .4) conformance with MOA COSA guidelines in effect on this date.• Engineer's Printed Name S7C_ s ''`Z .9' Date 5 (3(11 COSA yellow sheet_2-6-15.doc ----. GRAPHIC SCALE: 1 Inch = 40 Feet a(---- \ \ \ . I220-40 8o \BUILDING DETAIL t. \ 35 N.T.S. v v -=311 BFB ® , ° v a ° \ 50.2 III 111111111 B \N • z D tkb M M e 1"-___,\ N N ,, \ • �\V 6l•�0 1 \ rn\ N \ 26.4 12.2 \ CPI, -\\\\\` ,,J ,,,, \ ,.\ . \ , \ \L ♦N vv N - \ Uc \ \ 18.5 Z. \ (NI 37 \ , c;�P 1 MULTI-LEVEL 57. \ \• v F WOOD FRAME .0 \\i' �' o. e I \�0.5 HOME C,a .k\ • ��\\ \ \\\\\IS , \ \ \ i\1-0.5 co Cf oa rnn ii \,•k' 2 // A__ �J1 4'x11' Cont • ! \))3 °)1 0`� LOT 5 49 / ,--- //. ABOBBY F. BURNETF / CURVE TABLE 1 � 84/g / NO. RADIUS DELTA LENGTH 1Ale \\ ' \, ;� \ m 530.00 07'08'03" 65.99 �ssi_oN== Date Scale Legal Description D T T T' 5/21/2018 1" = 40' I hereby certify that the property described hereon has been surveyed BOBBY F. BUR E1 1 by me, or at my direction, and that the improvements situated thereon 2941 Carriage Drive Grid AS-BUILT LOT 4, Block 2, are within the property lines and do not overlap or encroach on the Anchorage, Alaska 99507 SW 0959 SOUTHFORK NORTH SUBDIVISION property lying adjacent thereto unless otherwise shown. That no (907) 350-5541 Drawn by Field Book improvements on the property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission BFB ASB 2018 PLAT # 83-242 lines or other easements on said property except as shown. // MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT ' • , 907-343-7904 On-Site Water and Wastewater Section I Fax: 343 7997 www.muni.org/onsite Septic Tank Advisors' Certificate of On-Site Systems Approval # OSC181207 Subdivision: Southfork North Block:2, Lot: 4 The septic tank for this property is 34 years old. The average life for a steel septic tank is 20 years. Typical replacement costs range from $6,000 to $9,000. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. This is an example of what the metal of a 30 year old steel tank MAY look like. ii '."..13 '< a _ {,� • ♦ kms. '?, ,^�•. g . ' .. • • 11 3 s ,2F f y�,rt; • :z.•.,:i.' N�j Y,, * tIP W IV- '�••,•3 r•Y' *.� f ..r '. .3 .-.vim } F_. ;rte 4 . i tN K - Y 4 •, w 1 a34/0„ •„ MIT! • v. . w `y ' , ` ,'w,.. - "'" h4., x , 0� • 'k iy,'&r..✓'}' ;',f,154 , ..4k, A'' t t ' 0 L : -..,...,....._14.� , 4.1 4, �,,Q t t aa. 2j 0�,8. `�J. 1,. g, * Ya� [�j .' • aa t Sys Mailing Address: P.O. Box 196650 *Anchorage,Alaska 99519-6650 *www.muni.org MUNICIPALITY OF ANCHORAGE v • 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 I.D. # 078-141-14 ,a HAA #f1g1 Mtn u GENERAL INFORMATION Complete legal description South Fork North Lot 4, Block 2 Location (site address or directions) NHN South River Drive, Eagle .River Property owner Donald & Rebecca Rhodes Day phone 694-0985 Mailing address Hr85 Box 9823, Eagle E ver AK 99577 Lending agency Alaska USA / Pamela Sloan Day phone 694-7030 Mailing address ' P O Box 196613 Anchorage, AK 99519 Agent N/A Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water 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 X Holding tank ' s. 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 5: STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application 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 Eagle River Engineering Services Phone Address Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 1 694-5195 Date _ 3— -5-- 5 7 AI .IG GS (\ O — pp a C<•�w<Ye 1 �1q c. vvv vYvv K.ur. d" a .' Lgylt A ,Pfd)he a 400 bedrooms, with the following stipulations: Date _3 —4O The Mupl.ciKlality of AnQhorage Department of Health and Human Services (DHHS) issues Health Authority, Approval CEirtificates:based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their leliding institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA #21 MUNICIPALITY Of ANCHORAGE ENVIRONMENTAL SERVICES DIVISION Municipality of Anchorage MAR 05 1997 0* DEPARTMENT OF HEALTH & HUMAN SERVICES16 Environmental Services Divisionjj�� cc, FF 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 34"3g9,f WE Health Authority Approval Checklist Legal Description: '!�OU%H6Ug2e Qlo1Z%N Parcel I.D.: Q'74?4W- Lai 4 ?- A. WELL DATA Well type �'rz�V�i%E If A, B, or C, attach ADEC letter. ADEC water system number N/A Log present (Y/N) Date completed 05/Sl% Total depth Cased to Casing height (above ground) / Sanitary seal (Y/N) yk5 Wires properly protected (Y/N) FROM /WELL LOG Date of test Static water level 2 Well production -30 9•p•m- WATER SAMPLE RESULTS: Coliform AT INSPECTION Ozh2 ? 3j 7,40 YX-15 Nitrate t461L-Other bacteria -0' Date of sample: 0 ?-/;? ff/9 % Collected by: '�5R'r-5 B. SEPTIC/H8t= MG TANK DATA g.p.m. Date installed Tank size /1O0 Number of Compartments j?- Cleanouts (Y/N) Y6is Foundation cleanout (Y/N) Depression (Y/N) %/U High water alarm (Y/N) /I/ 1A Date of Pumping 0q,/217 Pumper C. ABSORPTION FIELD DATA �/f�IGGGw Date installed /� Soil rating (g.p.d./ft2 er fftdrm) L System type T,-&,vc14 Length If# Width Gravel thickness below pipe 0,51Total depth Effective absorption area Seo Monitoring Tube present (Y/N) XS Depression over field (YIN) %r�d Date of adequacy test Results (Pass/Fail) ?455 For %WAt�C-E bedrooms Fluid depth in absorption field before test (in.); _ Immediately after gal. water added (in.): Fluid depth d (ins) Minutes later: 10® Absorption rate = i yin g.p.d. Peroxide treatment (past 12 months) (Y/N) %` If yes, give date 72-026 (Rev. 3/96)` D. LIFT STATION g/1 Date installed Manhole/Access (Y/N) High water alarm I E, SEPARATION DISTANCES mp on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: gallons Septic/hekiinq tank on lot. -/-Mo On adjacent lots "Pump off" level at* 71-/OG1 Absorption field on lot _ /-/()0 On adjacent lots /V00 � Public sewer main NIS Public sewer manhole/cleanout N�fl i Sewer /septic service line J-1-50 Lift station SEPARATION DISTANCES FROM SEPTIC/HQWD9MTANK ON LOTTO: Foundation _ �0 Property line Absorption field_ Water.11l&/service line ,�JO r Surface water/drainage Wells on adjacent lots %/OD SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line _ -?o Building foundation 2(P Water maWservice line Surface water 20 9Z004',JF Driveway, parking/vehicle storage area. Curtain drain - AWel /41YJY/'-Lr/;r Wells on adjacent lots f 6t) I F. ENGINEER'S CERTIFICATION /0 I certify that f have determined thru field inspections and review of Municipal record9'thaQIYl igbplvepystems are in conformance with MOA HAA guidelines in effect on this date. er Signature?y an = j H ;tyr>,yx •. s f• %j07e4e-fj,Look Engineer's Name Z--Ool' A. Date 3` S %'n�ery HAA Fee ' D -V Date of Payment _ �> s `l Receipt Number_ ��/ 6f7 / 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES}rj 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 I.D.# 078- Hi- 19 HAA# IYA q%L0a61 1. GENERAL INFORMATION Complete legal description Location (site address or directions) OM Property owner $o 1Lor'is Day phone b g4l— q,683 Mailing address I Lending agency o goy44c A Day phone Mailing addres Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: l Individual well V Community well Public water Day phone 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. 1191) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application 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 furtherverify 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 Vto t v7�0 Phone Address Engineer's signature 6. DHHS SIGNATURE 0 Approved for ! 1 bedrooms. Disapproved. Conditional approval for Date bedrooms, with the following stipulations: Additional Comments '� La4 Az, %,4-�1 111TIC Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA M21 MUNICIPALITY OF ANCHORAGE ~� • DEPARTMENT OF HEALTH & HUMAN SERVICES M j 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 I.D. # 07S— N l — I `fes 1. GENERAL INFORMATION J Complete legal description Location (site address or directions) Property owner l30 ✓vr 3 Day phone 69 gam! Mailing address Lending agency N e r u_-H,_A �4d Nr�'q a� Day phone Mailing add Agent�(/ 0( .o0( Lo k -f " Day phone 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 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 U21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application 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 furtherverify 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 _ o �J e 1 S b J✓ k a X _ Phone A- 7 4— 34 !lo Address ao 3. LXi / s 4-41 Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. a Date Disapproved. 2 Conditional approval for ✓ bedrooms, with the following stipulations: ", Additional Comments Iffir Date _ 7 The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (fiev. 1/91) Lack MOA N21 Municipality of Anchorage 'A �q Department of Health & Human Services _ HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �lz Sod 1-ork Nov-�j Parcel I.D. ® 79S- ly! — P-4 A. WELL DATA Well type If A, B, or C, attach ADEC letter. A/DEC water system number K/ Log present (Y/N) y Date completed s"�`� Driller-cy Total depth Cased to �n i✓ Casing height ys .� Sanitary seal (Y/N) y Wires properly protected (Y/N) >' FROM WELL LOG AT INSPECTION 6/B 17 g it: Date of test Static water level f Z_ Well flow 3 g.p.m. 6, 5 g-p-nLLIw y Pump level �V S SEPARATION DISTANCES FROM WELL TO: 3 Septic/holding tank on lot On adjacent lots i l L D "' Absorption field on lot i !! D ; On adjacent lots > 1 Z] �1A Public sewer main Public sewer manhole/cleanout Sewer service line i A6- Petroleum tank N )K/ ` ti WATER SAMPLE • RESULTS: Coliform Nitrate ' Other bacteria` ` y+ S � �'�`�" Date of sample: 9 Z Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 81SLy %_Tank size Compartments 2 Cleanouts (Y/N) - Foundation cleanout (Y/N) Depression (Y/N) High water alarm (WN) KzA Alarm tested (Y/N) Date of pumping' 4/10 (, R Z Pumper 1 S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot > 11 b On adjacent lots >,> 10 Foundation To property line - Absorption field [n -Water main/service line ? S U Surface water/drainage N l/ 0 72-026 (Rev. gist) Front - - CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent (Y/N) — High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manufacturer Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water _ Date installedAL3 s L/ Soil rating N System type ( AA�V_,4 Length WLd_Width 3 Gravel thickness _Total deptth/ ' Total absorption area _ Cleanouts present (Y/N) Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Date of adequacy test _Y17 21, e_ for 3 If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot _ > % 1 C) On adjacent lots 5 / / D Property line. bedrooms To building foundation _ 3 z— To existing or abandoned system on lot On adjacent lots > Cutbank N%1 O Water main/service line 0?5 Surface water _. v Driveway, parking/vehicle storage area Curtain drain _ b E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature J l Engineer's Name 1p J: Date � Z zl Z HAA Fee $ J 70 _ Waiver Fee: $ — Date of PaymentDate of Payment Receipt Number A?, _ LS1Z6/ Receipt Number 72-026 (Rev. 3/91) Back MOA 21 I MUNICIPALITY OF ANCHORAGE: DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date 1 / �i (a) Legal Description (include lot, block, subdivision, section, township, range) �,1. L1 �'/// -J Sr �/ t -r / YL/. ,7''z 7~ / :� ✓�..� ms's �:/ Jz�- �/ Location (address or directions), (b) Applicants Name l:,01,0 ✓,Business C% %/✓ i Applicants Address��,-r' (c) Applicant is (,check one) Lending Institution ; Owner/builder ; Buyer Other (explain); (d) Lending Institution /- rf/ n ;fig>.:/ />r;,, /t ;,JTelephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family' Number of Bedrooms 3. Water Supply - Individual Well Multi -Family Other (describe Community E:] 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 21 5. Engineering Firm Providing Inspections, Tests, File Search, Data and Information 2 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 /G� �r°:� S� <; >-1 / , -.:.( '� . Telephone J 9 j �G Address .�) c o e Date 9////!r %'' (ENGINEER SEAL) !!r.ees eNaf�.es.ariaie._n'��t��. No. 2225-E JUNE 25, 1971 �i9v DHEP Approvalk;': Approved for bedrooms By -� y-� CLQ c.ti%x� Date'' ° ` i'l�`�/ PP --�-- Approved /\ Disapproved Conditional Terms of Conditional Approval CAUTION THE MUNICIPALITY OF ANCHORAGE DSPART:IENT_ OF HEALTH AND ENVIRO:ZfENTAL PROTECTIONI 0HL1') ISSL!Fti ;?�; Al;1H :\4'THORLTY APF`OCAI CERTI; T_CAT_E5 BASED SOI: LY UPC\ .T_ E 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 21 7-19-84 Ml1mICIRA400 (OF ANCHORAGE IDEyT, OF HEALTH & PROTECTION �, �i MUNICIPALITY OF ANCHORAGE & idVIRONXAENTAL DEPT, OF HEALTH ENVIRONMENTAL PROTECTION �� MUNICIPALITY OF ANCHORAGE (MOA) V E D HEALTH AUTHORITY APPROVAL ( HAA) SEP 2 `184 E C E 1 CHECKLIST - FEBRUARY 1984 T I`�/ Z� U�/� Legal Description: 1/ A. WELL DATA �vs� j Z for GC /liuy tti Well Classification %��✓` If A, B, or C. D.E.C. Approved(Y/N) Well Log Present (Y/N) TZ Date Completed —'—" Z/ Yield Total Depth 61 Cased to Depth of Grouting y�4 Static Water Level Pump Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well; To Septic/Holding Tank on Lot On Adjoining Lots To Nearest Edge of Absorption Field on -Lot IeO 't On Adjoining Lots /oz 7` To Nearest Public Sewer Line �O'`L b To Nearest Public Sewer Cleanout/Manhole j✓— To Nearest Sewer Service Line on Lot Water Sample Collected By E%n:5 -�� ; Date Water Sample Test Results y ComTents C41s..,e z- 6., ' B. SEPTIC/HOLDING TANK DATA Date Installed ?2&- 'f Size /ova No. of Compartments Standpipes (Y/N) j Air -tight Caps (Y/N) /V Foundation Cleanout (Y/N) Depression over Tank T—(Y/N)—/✓ Date Last Pumped —Ale z4,1 Pumping/4aintenance Contract on File (Y/N) N for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Wall �Z9D To Building Foundation To Property Line �� fi To Disposal Field S + To Water Main/Service Line oZ5- To Stream, Pond, Lake, or Major Drainage Course Comments Lhrnk r 7�»�.. .�•-si�cf-^.��•-� - - - (Page 1 of 21 At4C_1 22 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata l� L/6 ,,,Type of System Design fir c -A Date Installed gzl�-y Length of Field //0 Width of Field _ �, - / Depth of Field ,,,0 Gravel Bed Thickness Square Feet of Absorption Area �yU Standpipes Present (Y/N) / Depression over Field (Y/N) /y Date of Last Adequacy Test Results of Last Adequacy Test /Vet -v Cor z Separation Distance from Absorption Field: To Water -Supply Wzll 1 y J fi To Property Line le / To Building Foundation _ Ov ' To Existing or Abandoned System on Lot_ - ; On Adjoining Lots 0,) �- To Water Main/Service Line S To Cutbank(if present) lyu'—�_ To Stremn/Pond/Lake% Major Drainage Course dUu-�-2_- To Driveway, Parking Area, or Vehicle Storage Area Comments LwsJ--O WtS- D. LIFT STATION All J Date Installed N Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested J -or Manhole/Access (Y/N) "Pump Off" Level at _ Vent (Y/N) Pumping Cycles during Adequacy Test. gets MOA Electrical Codes(YM) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines,in effect on the date of this inspection. Signed -Y J � /2�� Date /0////C7 Company��ti7`r�/�h��t MOA No. KB1/d5/s [Page 2 of 21 N y. ENG s • v *; .49TH .* + 1 r 4 V..t .rr. 9-11 i....l o� o. 2225-B •�t JUKE A 19U 2-15-84