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HomeMy WebLinkAboutT15N R1W SEC 8 LT 189T15N RIW ECTION 8 #051-154-28 •e I Municipality of Anchorage Page 1 of 3 Development Services Department On-site water and wastewater Program 4700 South eragaw Street P.O. Box 196650 Anchorage, AK 995194650 www.ci.anchorage.sk.us (907) 343-7904 ON—SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO30080 PID Number: 051-15428 Steve and Daphne Hambrook Wastewater System: New Adckvmw 19740 Scenic Drive Chu iak AK 99567 ABSORPTION FIELD µarbe`dBebeOm` 5641982 Four4 5' Wide Trench LEGAL DESCRIPTION sea Ftmena Taal Depth kare atiml grade: .8 Gp01FF 6 Ft. Bbdr Lat &Ldmaion: 189 Dapm b pipe bowm kom "rut areae: Gravel depth bwokh pipe: 2 Ft. 4 Ft. Tawuhip: Ranee: Section: FII meed above odpinel jade: Gravel Lenjh: 5N 1W 8 3.5 Ft 94 Ft. Well: Now cr.v.l wied,: Numberakrara: iarerwebeWw Mee: 5 Ft. 2 10 Ft Claaeiriatim (Frhara, A S. C): Tom Deptk CmW b: TOCal abwrpbon area: Pipe, is Private 400 Ft. 77 Ft 940 Fe ASTM 3034 PVC OilerDare Sullivan Water Wells Drilled Static avatar L": 4111 1 32 Ft Sanders & Sanders 515.7/2004 THNM 20 GPM PLNM set x Ft. C"rV H@VM new. Grcaral: >2 Ft. TANK SEPARATION DISTANCES O septic ❑ HOiding ❑ S.T.E.P. ❑ Other. To Septic Absorption Lift Hokfing uaklPdyam . From Tank Field Station Tank sewerune Anchorage Tank 1,500 well >100' >100' NIA WA >25' Steel Two (2) e &.%.weter >100' >100' N/A WA LIFT STATION - NONE ON LOT Lau* >5' >10' WA WA G,,. Fa.garbn >5' >10' WA WA �p mp Hgh�w In. m in. C~ Drain None Noted p"rw ° Mmw Electrical "awed'"" perwmw by: Remark.: BENCH MARK a� Garage Slab 100.0 Ft Engineer's Stamp OF aa••• • •���P�E ._. �,q obi Inspections performed by: TLK Dates: 10 515104 a to •i 2n0 Department of Health and H man Services approval • A� MICMAEI •E. AN j •. �% • ,J, No. CE -4381 •=ar ••� Reviewed and approved by: Date: D F9F,,, Municipality of Anchorage Page 2 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bregaw Street Anchorage, AK. 99519-6655 - 343-7904 On-Site Wastewater Disposal System or Well Inspection Report Permit Number. SW030080 PID No. 051-15428 50' R.O.W. Reserve A B S1 44.2' 6.7' Shop S2 46.5' 5.2' C4 60.4' 3.0' C5 46.1' 37.1' C6 71.8' 7.2' C7 61.0' 46.3' Ml 46.4' 41.6' M2 81.8' 51.0'C6 C4 s Alternate Site hi 5 � Q9 TH1 n ® v �. MC7 M1 Gravel Drive cs A / \ B / Four Bedroom Home \\ ® Well I® Well OF •�,��� C?' 3 49In ' .................. h... PLAN AS-BUILT ;MILiMEL E ANDERSON C- SCALE 1' • 0' �I��''•, No. Ce-4ael ••'air 89.11 89.10' Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw, Street Anchorage, AK. 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number: SW030080 TBM PID No. 051-154-28 I1-2$-2004 x17:05 Prom -GALLERY HOMES T-330 P-004/015 P-778 r. • 01,01/1939 aa: 35 69E:25', aLLIVAFt C PAGE 91/01 Certf fteb O t[ling I Dg by ox co.dbw SULLIVAN WATER WELLS P,O- BOX 67OV26 CHUGIAK, ALASKA OM • TELEPHONS 686.2788 L70020 tt A1NN'cR bF LAND: �`�Lt�l�t' �` 1C`% '�"" "-'• ' r-c►-Gil��._ BORE'ROfaw't5'ATA"_.._..._...,._._,...,..•.. .,,,._._. ADDRESS:..,_ LEGAL DESCRIPTION: 'r i S: /A1 R-1 (AJ ^��yC�. t.ATF. PERMIT NUMBER: 03-mpo Date of lS2A q„ •[.T -'d TAX IDENTIRCATION NUMBER: O'FL1. 15.4 . cW . S wen located at approv permit location? �j No Method of Driving: air rotary rj cable tool Depth of wen: 4� i Casing Type gZ4j§z_W211ThCkrtE+W1=?Aa_ Inchas Diameter-�Inchas depth Llne'Type `6.a2it Casing Stickup Above Ground: t Static Water Level:- Met Recover Rate: 1,4p Method of Testing: - 6 Lo If i Well Intake Opening Typc U open end t tole j Screanad; Start feet Stopped - feet uPerforations start fer�,j�Jgppad foot Grout type nfTD%Atlr *' �'llffume/P��1tr _L$QC.d_C, Depfh: from k feet`, to— o -rtee, Wen !)Wnfetted Upcn ComtOS latorY? ibs :1 No Method of DisinWillon: _e_jtWvk j f 5"D hpzn Comments 2e 610N 1Fr'Vje- A,Qtcc#,4& !'r bpm A•r:YxG hlJyjka gAoit-iofv r^b X-ne,oc P A i 7 I � r e c J J J Driller'S Name ATTENTION: It Ls trim re,ponsibl8ty of me property Owner to SUbMit a copy Of the of Anchorage: Department of Health 3 Human ScvKes anc%r Daa�rtment of i nctronmental well tog to iris proPff authottty. Municipality DeFartment of Environnentel Consarvetion Oo"Bervation. Matsu Borough: 12-08-2004 16:38 From -GALLERY HMS +6076623617 T-406 P.002/002 F-471 cerfifteb wntttna taff by SULLMAN WATER P.O. &Z V=Z MMMK, AUUIM 89M7 dWNBiOF[JWD�Sr JE �IDAa,�a•,��' �.�� �; , WELLS 6 06 - zTs9 666 -Zas47 .. r, I . 17 . ru a •� Oepmormt ��TYneslNaII � �� • C!*QSUChV AWmQ=mft Te, St ftwi a Lela IBM R=tw ftm a -a M► 11 amd drag rtw Al WM Wake OP=QType: a Apert mrd 'tSr_ * Stan feet Stopped Sect o Petbm= Start C,'VATypr^ � N••t►f`� CtRtiut Bt feet _ 4:i�S.r� —/n/s�d,G�� C�t,�✓ 1lLro�,�.� L3�de4c K tS2�,s..J a MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water 6 Wastewater Program 4700 South Bragaw, Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WATER SUPPLY PERMIT Initial Date Issued: Jul 13, 2004 Expiration Date: Jul 13, 2005 Permit Number: SW040262 Parcel ID: 051-154-28 Legal Description: T15N R1 W SEC 8 LT 189 Design Engineer: 0011 Constructing Engineers, Inc. Site Address: 019740 SCENIC DR Owner Name: STEVE W. & DAPHNE D. HAMBROOK Lot Size: 108900 SQ. FT. Owner Address: 19740 SCENIC DRIVE Total Bedrooms: 3 Permit Bedrooms: 3 CHUGIAK , AK 99567 - This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. Ail 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 engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. THE INSTALLATION OF A WATER WELL SHALL MEET ALL THE ANCHORAGE MUNICIPAL CODE 15.55. PLEASE SEETHE ATTACHED SHEET "PERMIT REQUIREMENTS FOR A DOMESTIC WATER SYSTEM". IF THERE ARE ANY QUESTIIONS PLEASE CALL THE MUNICIPAL ON SITE WATER AND WASTEWATER PROGRAM AT 907-343-7904. Received Date: % " � % - d y Issued By: M� Date: TA/ 011 t Municipality of Anchorage A�- Development Services DepartmentBuilding Safety DivisionOn-Site Water and Wastewater Program int r 4700 South Bragaw St. 6 5� P.O. Box 196650 Anchorage, AK 99519-6650 / 040974. www.ci.anchorage.ak.us H YR�W,� (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION 90Z ' NOgo FOR A SINGLE FAMILY DWELLING Parcel I.D. O.S/- /SW- -28 Permit Number SW Property owner(s) 5 At k>, 1011001$�15_ P, h, a1c' Day phone 030-zIP6 Mailing address (1) , e2 Ago Mailing address (2) -ML -10 00M Legal description (Lot, Block & Sub'd.) oaf !E 9 Legal description (Section, Township & Range) _52�c2W evs- /j lel W St G 9' Lot Size (DB,gbZ) kc. Sq.Ft Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well _y Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ 1 certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) v -o Permit Fees: X75' Waiver Fees: Date of Payment: �` C Date of Payment: Receipt Number: 4�0—i Receipt Number: (Rev. 12/00) A -7 /1 k/ �-TISt I — UIU ! P.lo—nt ILCLW—R.. a — — — , r 4 Y S89•5 "W 2 9.85 I I I i -i B S 589.54.00"W 330.13 (Roc) BLY 1589'52'27'W 330.04 (Neo&) (79-130) A Ir, I �l 137c JE NRMB r;�©k, It If If I Sire, FIC.h Lof l --------j)------- Bsok 251 Page 71 i�o�os 30' R.O.W. R. �J 0-c- L 330.200 Sca.. (l, f',= 100, .4 11 /, P) Baak 23; n !0' 4 0 W, Rsssrve ,flx fi«a , Book r7�:,Por rosmd Jo GA /, /1It ❑ N CA, 2I W � a s � �o N Beek 318 Page 320 / !0' R.D.W. Rn. e Book 237 Peg. 20• Public Uss RDW /1 4 -y -0J q T r5N, R,' 1 VJ c` props V4,/ as ,AASkc wb% o h +-41S Siff, p1co, Mw ddpaIity of Anchorage *A9 Development Services DepartmentBuilding Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 198650 Anchorage, AN 99519-8650 www.ci.anchorage.ak.us (907)343-7904 ON-SITE SEWERIWELL SUBMITTAL COMMENT SHEET To: am2awE Legal description: T15N R1W SECTION BLOT 189 The attached paperwork has been reviewed and is being returned for the following reasons: ❑ Original signature or stamp missing on ❑ Calculation error in design. ❑ Additional soils information needed. Water monitoring results inadequate. ❑ Discrepancy in information submitted.'_ ❑ Topographic information missing or inadequate: ❑ Incomplete; missing _ ❑ incomplete; missing _ ❑ Additional adequacy test information needed. ❑ Water sample unacceptable: _ ❑ Measured/proposed distances/dimensions missing. Locations of all soils, percolation' and water monitoring tests not shown. ❑ Proposed system too deep for soils Information submitted. ❑ Well log required. _ — ❑ Omission in narrative. ❑ Insufficient fill over tank or field._ ® Other. THIS PERMIT IS PUT ON -HOLD FOR THE FOLLOWING REASONS, ,THE PERMIT APPLICATION 1 Name of reviewer: ,JOE GOODALL Dater 7/20/2004 Please supply the necessary information and re -submit your request. LEAVE THIS FORM ATTACHE© TO THE PAPERWORK Municin ali T of Anchorage pPG£ y< Mark Begich, Mayor SA ET/ Building Safety Division P.O. Box 196650 • 4700 Bragaw Street Anchorage, Alaska 99519-6650 • (907) 343.8301• Fax (907) 343-8800 http://www.mmi.org April 29, 2004 Steve & Daphne Hambrook 19740 Scenic Drive Chugiak, AK 99567 Subject: On -Site Water and/or Wastewater Permit. Permit Number: SW030143 Legal Description: t15N R1 W Sec 8 Lot 189 Dear Mr. Hambrook: An On -Site Water/Wastewater Permit, number SW030143, issued by this office for a single-family system, will expire on May 20, 2004 This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well permit. If you have ,any questions, please call this office at 343-7904. Sincerely, i J s Cross, P.E. M nager On -Site Water and Wastewater Program Enc: Copy of permit MUNICIPALITY OFANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 19665Q, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW030143 Legal Description:715N R1 W SEC 8 LT 189 Design Engineer: 0011 Constructing Engineers, Inc. Owner Name: STEVE W. & DAPHNE D. HAMBROOK Owner Address: 19740 SCENIC DRIVE CHUGIAK , AK 99567 - s/ 0L_(_ 3P Kh S I --� j oq - I em Date Issued: May 21, 2003 Expiration Date: May 20, 2004 Parcel ID: 051-154-28 Site Address: 019740 SCENIC DR Lot Size: 108900 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: ❑✓ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. Receiv Issu Date: J '? t—a3 Date: .5-1121,10.7 Municipality of Anchorage • Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St.. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907).343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 10Z5_1 -1S V _-2 0 - Permit Number SW O30 %4 ? Property owner(s) S7_ W V CI-VXPMlrE Day phone 7 ` 7 2r2 �-�tG6r ivr i Mailing address (1) 1OE�11 6VoPP4STtR C kb/AK- S address (2) I T 74O ScE#lc ORI vE '47 Zip Code `�9S77 iia �/ro Legal description (Lot, Block & Sub'd.) `, yV / C Legal description (Section, Township & Range) T/�/V �5 / sl� Lot Size A5iri. 'MO AcreoSqFt.Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only X Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information Is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property gwriier or authorized Permit Fees: '1-40n. OC) Waiver Fees: T Date of Payment: 01 Date of Payment: Receipt Number: T-1 0-) Receipt Number: (Rev. 12/00) HANK WILSON CIVIL ENGINEER LAND SURVEYOR CONSTRUCTING ENGINEERS 9601 BUDDY WERNER DRIVE ANCHORAGE, ALASKA 99516 PHONE/FAX (907) 346.2000 /Z / W, SEG 8, P• /• D• o5-1-* /Sel- 2. /77f4po Sr. E/V/G DR. NEw sEP'lis 5 0T'e'44 To SE2 ✓E h PRDPo.Se /j 13Enieco.,+-t HoAsl E je P'e/a*rE S/foP ui A eCS- rf o o on . .'• 5-/E6 .5'y37-601 7'= 02. 5• ZZ i/fc pgveo5 p or r.or /8'9 wlf,c. "or .40r,�RsEG.y A �F��% .�O 4 c G -`v7 Pi�aPE.t'Ty /4.s sgo w.J p N �o n. ?ERG R i4-rES = to/, •i v!ti . No w*rE2 vBsERvC"D /N 7'E'sr /0/T �L wNcri dos A•P2« 26., 03/' 02 i440A.IjAP il Al -7/ °3 ' Z 'f W. Tc -R © BSER VE'D /AJ r63 r w#6060) a v g /4 -PA /G Z 64� AtoNi j o2 Ep M A f 7. P17 -S ZZ' -PEE'P GESS G ' FoR Oe D,2vc/C = /G t 3vr .. 22 - Z� w/¢ic2 6vrq-rE? A03P e i % /Z EA-1CA*C r0/7 5*Y.5 Cv. . /Z c /zea-VeZ , Z.= /5-0 4Pp 46ic s- 64 r f ! /2E,vc fi w / 2 SElvE/L ,Zvi/< HANK WILSON CIVIL ENGINEER LAND SURVEYOR CONSTRUCTING ENGINEERS — USC 15-490 I at/4", .54Lp,-IC, g'•eq/< . 9601 BUDDY WERNER DRIVE ANCHORAGE, ALASKA 99516 PHONE/FAX (907) 346-2000 /¢/� u�o✓�� �s'►OL Ae"elat,�t C(4, %-- �S doer' 4411 /s&S 'Tec= moo# Vlclgy /VP/G✓}cl 76 -EP j-,z�A..)CF4 ,2 Eqv�/z FM Eur. 4� SPEC S jg:�'o/Z itiEgd.Fl7g,o �E�/tt'/G .t 5E� si; PGf}-AJ X02 pje49�oS�j 6rodC vc 71-PifAAE /44446400< Pow /0oG5:7 i9 GhFj 444, 4 9 5-/O 069-7 .; NO. V324 amIL19" 0'-1-a3 .4 -7 /1 / l4 / / V No .JcvEGoNrYIEaJj w/r'it/nJ 200 or- Go> i�9 i s ..,...— - T • UW L P.bok S89.34'00"W 330.13 (Ree) BLM SBO92-27-W 330.04 (Mode) (79-130) rl lU i)E vEC-0 PED I 1 .4 I I I ( Book 350 Pape 71 30' R.O.W. Rose... / l/ l/ 3EPTic Aleo9 C>YP� Book �cIA-1.,,s+ o *1 MO. um IBM a. Ifts T-0-00-3 rld / t A)O l7 MEN J /KJ 17?iP*I 200/ OF 4or/Y9 I Book 22 Pape 324 B.' R.O.W. R... Book 237 Pape 4 0 rT L e . lJ 30 20• PWI(a U.. Roe VEL.0IOW 007' OAJ WEST �Z pF' GOY1 w 330.20 e +! Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: -5/�C //-!/50�� DATE PER FOF�IGMFyD:-99RCM ' s t LEGAL DESCRIPTION: 64'M 4-07- /y / Township, Range, Section: "A/ ,e � Gt,% S-ec. 8 --- DEPTH (FEET) -1/1j4 1 21 /- V sez✓ti„y 3 .rl /1-/ 5 /!o 6 s>,r7c('l s�a✓<-1 CSP- SP 8- 9 10 11 12 13 14 15 16 17 18 St #/ 51'JVt l 1s 4 M SLOPE -2-03 WAS GROUND WATER 00 ENCOUNTERED? S IF YES, AT WHAT LO ✓ DEPTH? P E lisp@ Wl�(et, Manlloritinp? ` Batt zo -� L_J PERCOLATION RATE (minutevmeh) PERC HOLE DIAMETER zZ-r � 11 LL TEST RUN BETWEEN FT AND / FT COMMENTS /'QST ��T ©/]yet/!/GS //'-C✓l 0VS41/ '.Sf//', PERFORMED BY: A/1 All A///5c"7 1 /4 / , 49f 1501 CERTIFY THAT THIS TEST W`/.S PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: T -7-G -M l 5-7-03 72-008 (Rev. 4/85) ®®mmm J A 0 ■■■■■■■■■■ �i'i��DEI'■i�■■ ■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■■■■■ WAS GROUND WATER 00 ENCOUNTERED? S IF YES, AT WHAT LO ✓ DEPTH? P E lisp@ Wl�(et, Manlloritinp? ` Batt zo -� L_J PERCOLATION RATE (minutevmeh) PERC HOLE DIAMETER zZ-r � 11 LL TEST RUN BETWEEN FT AND / FT COMMENTS /'QST ��T ©/]yet/!/GS //'-C✓l 0VS41/ '.Sf//', PERFORMED BY: A/1 All A///5c"7 1 /4 / , 49f 1501 CERTIFY THAT THIS TEST W`/.S PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: T -7-G -M l 5-7-03 72-008 (Rev. 4/85) ®®mmm J A 0 J A 0 OFA . , •tea _ ..�", • N• Municipality of Anchorage N�ee � DEPARTMENT OF HEALTH 8 HUMAN SERVICES t �� NO. 825 "L" Street, Anchorage, Alaska 99502-0650 iii__ SOILS LOG — PERCOLATION TEST PERFORMED FOR: 5' 45 -' DATE PERFORMED: � Zz G� � � ��"1+7J LEGAL DESCRIPTION: 3c"m zo 7- Township, Range, Section: 7-/-5-/4/ 2/&V Sec Q DEPTH 1 SLOPE SITE PLAN (FEET) I D— Z 1 49 r5 a�ffc5� T 2 31 ( Z-" J-'P7dy s//7' 4 5 6- 7 �ravtl/� �zh� 8- 9- 10 9 10 11 12 13 14 15 16 17 18 20 q ZD ; 2//Z PERCOLATION RATE (minuteainch) PERC HOLE DIAMETER TEST RUN BETWEEN / FT AND FT COMMENTS WATER ENCOUNTERED? (/ t - IF YES, AT WHATX10 F DEPTH? !� riwaAf- I i�Dz Allan DOPM ri ? 7 U Date: �� J Reading Data Gross Time Not Time Depth to Water Net Drop C—z 0117 fI %30T O1✓i % '1 cy o.�► PERFORMED BY. __/71 /7 ' k0f Iry &J I —/r /'y' CUr I -,SO ✓I CERTIFY' `THgAT, THIS TES¢T�rWAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: T' Z6 , D3 T S- 7' ,03 72-M (Rev. NaS) Permit Number: SW030080 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WATER SUPPLY PERMIT Initial T.;tegaf Description: T15N R1 W SEG 8 LT 189 Date Issued: Apr 15, 2003 Expiration Date: Apr 14, 2004 Parcel ID: 051-154-28 Design Engineer: 0011 Constructing Engineers, Inc. Site Address: 019740 SCENIC DR Owner Name: STEVE W. & DAPHNE D. HAMBROOK Lot Size: 108900 SQ. FT. Owner Address: PO BOX 100687 Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99510-0687 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy ❑✓ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). ( Not required for a Water Supply Permit only). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. .. � rte... TFie following special prdV�sions.- ETHIS PERMIT ISSUED EXPLICITLY FOR WELL WATER EXPLORATION. WHEN THE WELL HAS BEEN COMPLETED AND SATISFACTORY WATER PRODUCTION HAS BEEN DETERMINED, THE WELL DRILLER SHALL PLACE AN APPROVED SANITARY SEAL ON THE WELLHEAD AND NO PITLESS ADAPTER OR PUMP SHALL BE INSTALLED.UNTIL AN APPROVED WASTEWATER DOSPOSAL SYSTEM HAS BEEN CONSTRUCTED, Received Issued By: Date: *113-103 Municipality of Anchorage • -� Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel LD. ���'��/ :Z ?—e4e'70 Permit Number SW 6300,0 Property owner(s)iAi �XOD�f'. Si�YEl•1��1P.fi1/�' 1/ Day phone Mailing address (1) TO$y� 6�a7J�PfIsT1" e1A , / Mailing address (2) �/9lr %� 9) ✓��l i /1 t< _ Zip Code f fS %7-82Yf Legal description (Lot, Block & Sub'd.).4 7 - Legal Legal description (Section, Township & Range) Lot Size /670' q VAyjF6Acres/Sq.Ft. Number of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well ❑ Water Storage ❑ Sewer Upgrade ❑ THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. Permit Fees: P5_0 Waiver Fees: Date of Payment: �it E03 Date of Payment: Receipt Number: 9 Receipt Number: (Rev. 12100) q. n I 'I 0 5 TYrJ (i YP, il; .4 i A -7 /1 � A /7 /1 I '� to 1�.-r r� ,�r.._�,�'7 �;,_'� �• � 3a.p+��.. avaak,- I ^H 17EVELa�wtt:ti'' (TA tJ fou/ Lei 1 ?I C N1 OF LOT [Fi� I .J 33 6sek 250 ?Po4.: 106 a 34•+aN•t 0.R. Roger's Book 234 Po0a `i45 3Y R.OAM Rw•rw , I Reek 218 ►a0. 324 N89.5V56"B' `329.68 Maol Y""'.(79130 N89.2030"E f`3J0.84 Meaa 7 -1 30.13 s NSQ-.- '50" 860.49 ^. s a x •o u 60 O,w, Murw 50' R.O.W. Ro n 4 g9. Book J7 Pa4. 3e4 Beek 237 Peg• a --'..--- ------ — 'per•---- rUt4 2 Patent RAW. Res • � � — •Z a0 / .} � �I $0p¢A — — — — �",ry" I Y w 589.5 "w ..$tet 5'Q• �'A 2 9.86 .n'-/ / / l' ❑ I / li ieN GI -V 0. o� I f -0Y 50-ole- #-v epht: �j�roPos9 I WI zz� +to/o wa11 i n Z. r S , 3foP4. ? S Imo: -Retest. 4... .....'✓ AAI 0..r 50 0 S89.54'00"W 330.13 (Ree) BLM 20• Publit Use ROW 589.52'27"W 330.04 (Maas) (79-130) — — — — — — — — — — V ri E tl E L O t3f L,q N o I -1 / .4 PC a8R p/J WEST I / • r Si' i' D F C D i e 1 NO. , w IL I�_I_w.na___Lo_f_( `i Tt5N, 21 � Book 2se Pao. 71 r Vo too 5 enc JAR. J O `7 VVit'M1 -k- W a -J (/2;1/' R"A S•' R.O.R. 0—&D cu`eA E Pro .a.(ri-N ,(G�(OW &N B V)�—. l S r � 00014330.20 3300.20.20Ross/ a.S (r, 5C -p— (.L _i'( -- 1001 GRE, ,-R ANCHORAGE AREA BOr Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 'GH INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION LEGAL DESCRIPTION [~r J~ "~'~ ~IF~/ /~lJ/~/ ~"~ SEPTIC TANK: DISTANCE FROM WELL INSIDE LENGTH MANUFACTURER. . INSIDE WIDTH MATERIAL LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY /'~ GALLONS. SEEPAGE PIT: NUMBER OF PITS . LINING MATERIAL BUILDING FOUNDATION ADDITIONAL ABSORPTION I ',v :zz'x DIAMETER ""/~)~ OR WIDTH LENGTH DEPTH CRIB SIZE: DIAMETER~ DEPTH ~1 DISTANCE FROM: WELL TOTAL EFFECTIVE ~, NEAREST LOT LINE ~l ABSORPTION AREA (WALL AREA) SQ. FT. WELL: TYPE BUILDING FOUNDATION CESSPOOL APPROVED CONSTRUCTION ~'/~ 0t~O-.0 NEAREST NEAREST LOT LINE SEWER LINE OTHER SOURCES DISAPPROVED REMARKS DEPTH DISTANCE FROM: SEPTIC OO~.? SEEPAGE TANK , SYSTEM ¢~'/ DISTANCES: INSTALLED BY: PiPE MATERIAL: LOt SLOPE: REMARKS: Form No, EQ-031 DIAGRAM OF GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 'ICr' STREET ANCHORAGE, ALASKA 99503 TELEPHONE 274-456I SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT PERMIT NO. INSTALLAT,ON LOCAT,OH INSTALLATION OF: SEPTIC TANK TYPE AND SiZE OF FACILITY TO BE FINANCED THROUGH PHONE NOTE~ THIS PERMIT IS NOT ID WITHOUT BOIL TEST FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITy WILL BE SUBJECT TO PROSECUTION. DIAGRAM OF SYETEM FOUNDATION TO SEEPAGE PIT ~;~ / SEPTIC TANK, ,J~/~Tt~ ~ , SEEPAge PIT . DRAIN FIELD · DRAIN FIELD SEEPAGE PIT /~c'~-) ALSO CONSIDER AREA WELLS. , SEEPAGE PIT J~/] DRAIN FIELD CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION § FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON P[PEB ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. ] CERTIFY ~HHAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS JN ACCORDANCE WITH BAil3 CODE. ANCHORAGE FAIHBANK§ JUNEAU September 13, 1974 Clabo Construction P. O. Box 3-4056 Anchorage, Alaska 99504 R&MNo. 462079 Re: Test Hole and Soil Log Report for Sanitary System Government Lot 189, Section 8 T 15N, R 1W, S.M. Dear Mr. Clabo: ~ We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed in accordance with your request of September 10, 1974, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 189 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor-mounted backhoe, and the test hole was extended to a total depth of 13.0 feet below the surface. The final log prepared for the test hole has been included in Drawing A-O1. Ground water was not encountered in the test hole. We appreciate being given th±s opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M CONSULTANTS, INC. xc: GAAB TH-1 ORGANICS ORGANIC SILT GRAVELLY SAND (SP) 0,0I 0,5' 3,5~ SILTY SANDY GRAVEL (GM) 8.0I GRAVELLY SAND (SP) 9,0' SILTY SANDY GRAVEL (GM) NOTE: NO IVATER TABLE Test hole excavated with tractor mounted backhoe 13.0' DATE D042273 Engineering E~ Geological Consultants Inc. ANCHO.A~E ~A'"EA""S ALASKA Clabo Construction Log of Test.Hole Anchorage Alaska scA[.~ 1"=2' DWN BY B.H. CH,D aY W.E.D. P~ou. NO. 462079 DWe NO. A-O1 /A Im "d. Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and 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 FOR A SINGLE FAMILY DWELLING Parcell.D. COSA #_ Expiration Date: 1 — 7— 0 7 1. GENERAL INFORMATION Complete legal description TiSn/, /Z Location (site address) 19 lye PR eHd�,,9K . AK 91/SG7 Current Property owner(s) 4P711Z 9t DAP,WE iid/i7BR09i('Day yhone Mailing address Lending agency Mailing address Real Estate Agent Mailing Address ,PopPoXG7ozs'9 cHv6�AK, AK 995-67-0�� 9 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well N Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site CK Individual Holding tank ❑ Community On-site ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Onsite 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. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. NameofFirm Cd>A3�v,oe,4-,o5 Ert�r.taars Phone �J�b'L000 Address 9661' hol&VV AVNS-1-- kit- 17150i Engineer's Printed Name N1 N, w t r.5 onl Rate w bm Haze + Aue. x8, lsrt 5. DSD SIGNATURE Approved for bedrooms.E�.'� Disapproved. �•�' E°' 7 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other gy;-1� (/ v_<, f Original Certificate Date: \ �- Municipality of Anchorage Development Services Department Building Safety Division On -Site Water-& Wastewater Program', - 4700 Bragaw Street P.O. Box 190850 Anchorage, AK 99519-8850 www.muni.org/onske (907) 3437904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: L•of f11 TfsN Rtw 3 8 ParcelID: 091- /sH-L8 A. WELLOATA- Z6ACav PuMlep rata A eoenmow! S71wit4eve r44k Well type If A, B, or C provide PWSID #_ Date completed Y_/o•!p T • MY Sanitary seal (YM) Y Total depth YOOL10aft. Cased to 11LtAft. FROM WELL LOG Date of test t•1e311•L3.9 Static water level 3La (to ft. Well production 0.33, 2#0 g.p.m. WATER SAMPLE RESULTS Coliform G colonies/100 mL Nitrate .4MRI. mglL a3/1. Arsenic: 34 L Hyl Date of sample: 7•Lf•7 B. SEPTICIHOLDING TANK DATA Well Log (Y/N) Y Wires properly Protected MN) _ Casing height (above ground) 1.4 + in. AT INSPECTION 7• LS•1 3 zo 0J6. Z, 17 g.p.m. — I Other bacteria O colonies/100 mL Collected by. Co.rsti. S=n!ps Tank Type/Mate W 5"+-%L , 34•e4.1 Data Installed 5--5.4 Tank size f SO a gal. Number of Compartments 2• Cleanouts (Y/N) Y Foundation cleanout (YM) i Depression over tank (Y/N)vL High water alarm (Y/N) N Date of pumping $•/' Pumper 3-9 S C. ABSORPTION FIELD DATA Date i(rstalled 41 Soil rating (g.p.d.i a ei#i AAM) • t System type S WIDE TKEN c.fi Length%0;—,tft q Y/,�'�' Width S ft. Gravel below pipe 4 Total depth : 4 Efl. absorption area fe Monitoring tubeY=Z Depression over field N Date of adequacy test 71 ZS• 7 Results (Pass/Fail) P For IL bedrooms Fluid depth in absorption field before test TTl�m Water added TSbgal New depth7`'Ll in. y 4a Elapsed Time: I�min. Final fluid depth'+(]in. !Absorption rate >= TSD g.p.d. Any rejuvenation treatment (past 12 mo.) (YM & type) N If yes, give date 4 vat.l.L^+s v2" sysk." s.% .L A,4vou. 4% k -k.. 'Ilro 3w) w.d♦" _&e fIV4. D. LIFT STATION ' NOuI E Size in gallons Ma ocess (Y/N) - i "Pump on' level at _ in. "Pump off" level at _ in. High water alarm level at in. i Datum Cycles tested Meets alarm S circuit requirements? 1 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAttt station on lot ? r • ° On adjacent lots /00 Absorption field on lot ° On adjacent lots / o o Public sewer main / ° 0 Public sewer manhole/cleanout Sewer /septic service line 7 S Holding tank N00 dr Animal containment areas a0N B AA°rAl D Manurelanimal excrete storage areas A,/°A+e A/0171t' D SEPARATION DISTANCES FROM SEPTIC/14=0*04ANK ON LOT TO: Building foundation 7 -'�' Property line ? So Absorption field r Water main 2,10 Water service line r o Surface water Wells on adjacent lots /ao SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line % / o Building foundation i / o Water main / o -- .. .7. . Water Service line /0 Surface water 1 io o Driveway, parking/vehicle storage ! LS s. Curtain drain 1 �o ° Wells on adjacent lots /0 0 F. COMMENTS G. ENGINEER'S CERTIFICATION �fp� �%owl� f certify that I have determined through field inspections and 4 review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date.�� " s Engineers Printed Name Cort r �. E��s'r N. /� W/LS ON �� V Date �•� 8' Zo�7 "tog .yam. COSA Fee $ Waiver Fee $ Date of Payment Date of Payment Receipt Number g8 13� Receipt Number (Rev. 11105) ANALY 1 ICA aRut 1• Construction Engineers Atm: Mr. Hank Wilson 9601 Buddy Werner Dr Anchorage, AK 99507 46-2000 Fax: ( Fax: (907)346-2000 Jte. V~ Client Sample ID: Sampling Location: Larie BLM Lot 189 Client Project: Construction Engineers Sample Matrix: Aqueous COC b: PWSH: Residual Chlorine: Comments: LabH: A0707313 -02A Analytica International, Inc. 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-259-6634 Report Date: 8/1512007 Receipt Date: 7/2612007 Sample Date: 8/2x2007 Sample Time: 1:20:OOPM Collected By: I I W Fie Definitions: MRL - Method Reporting Limit MCL - Maximum Contaminant Limit B — Present also in Method Blank II - Exceeds Regulatory Limit M — Matrix Interference J— Estimated Value D — Lost to Dilution • • — RL higher than MCL; target not detected TNC - Too Numerous to Count - result rejected CF- Confluent Growth - result rejected TCNG — Turbid Culture No Growth - rejected Analysis Method Prep Prep Analysts Parameter Result Units Flags MRL MCL Method Date Date Analyst -Family Well Water Arsenic 3.12 ug/L was 0.15 /0 200.8 8/1312007 8/13/2007 KS Page 4 or4 AN:V.Y FICA (cl)t r Construction Engineers Attn: Mr. blank Wilson 9601 Buddy Werner Dr Anchorage, AK 99507 (907).346-2000 Fax -(907)346.2000 Lab#: A0707313-OIA Analytica International, Inc. 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: 8/152007 Client Sample ID: 726/2007 Sampling Location: Larie BLM Lot 189 Client Project: Construction Engineers Sample Matrix: Aqueous COC #: PWS#• Residual Chlorine: Comments: Lab#: A0707313-OIA Analytica International, Inc. 4307 Arctic Blvd. Anchorage, AK 99503 Phone: 907-258-2155 Fax: 907-258-6634 Report Date: 8/152007 Receipt Date: 726/2007 Sample Date: 7252007 Sample Time: I d10:0OPM Collected By: II W Floe Definitions: MRL - Method Reporting Limit MCL — Maximum Contaminant Limit B — Present also in Method Blank 11- Exceeds Regulatory Limit M — Matrix Interference J - Estimated Value D — Lost to Dilution •• - RL higher than MCL; target not detected TNC - Too Numerous to Count - result rejected CF - Confluent Growth - result rejected TCNG - Turbid Culture No Growth - rejected Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 9222B (Aqueous) - Membrane Filtration MF Tear was conducted by: Analytica-Anchorage Bacteria, Other -OARL CFU/IOOmL 1.0 72612007 726/2007 PL Total Coliform Qv1RL CFU/IOOml- 1.0 J 726/2007 726/2007 PL Lab#: A0707313-OIB Analysis Method Prep Prep Analysis Parameter Result Units Flags MRL MCL Method Date Date Analyst 4500-NO3E (Aqueous) - Nitrate Test Nitrate as N <MRL mg/L 0.10 JO Page 3 of 4 Anchorage 7282007 7282007 AJ 08/20/2007 12:22 9073449821 JRs Pumping PO Boz 773415 Bogle RiMAX 99577 (907) e94E454 " !R inronnatlon- JRS SEPTIC rA(= Hl Service Agreement Number. 023673 Order Date: 23 -Jul -2007 Service Date: 01 -ALU -2D07 12:0 Technician: Dan Steve Hambrook Jab Dserpen: 15W PO Box 670229 P.O. Nunt.: Chuagiak, AK 99567.0229 T" d Net 30 Tax: 0 (907) 668.1542 sakerep: Dawn -Dawn JobTtpr Repeat Map nook Map Gild. 34 . . ob 8he Infomutfon cfO•e $°"d'' Jayttawk Drive Steve Job Cm Menu lfi--nat SWV Unknown New Customer i 19740 Scenic Drive Chuglak, AK 99367 � (907) 666-1542 Dumped tank clean 862-1542862-1542I Additional Location Comments dream: 5 tDW9oMn 22M bila Galion& Planned: 1500 rrs on Ice Color Homo - Gato 3 dog Gat. Actual Septic 9b middle of Yard a Service Type Septic Service 1SK Qty Price Each Tax? 1 $135.00 No Hose Length: 1.5 Double Tank: O Pump System: 0 Baffles INeL G Baffles Outlet: ❑ Extension Actual $135.00 NeaTeaeble Tatd T""Yet.1 To Toed Crnad Told Eawnred CharOr 5135.00 $0.00 $0.00 S135.00 Acted Chargec Cantmr a¢4e4 eotw lrna wA ewdeCns *roar. TMS IS A BINDING AGREEMENT. Slenaare nd TRN d Cusimm Repre•entdaw Dare AccpYd by JR4 Pawnpkta Dar Acaprd FnW added a:arweme m we iw pt Ammkrl Evrsea. Dtmrr, Viae and MaFW Carl Payrents 0 the Pnaae. Athr 30 Drfe S=Wt M be toned o to COU.ECTIONS. $30.00 Far NSF Ch.aM R4kaned. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program . 4700 South Btagaw St P.O. Box 196650 Anchorage, AK 99519 650 www.cl.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 051-154.28 HAA# Q n O Expiration Date:O5 1. GENERAL INFORMATION Complete legal description Lot 189 T15N RIK Section 8 Location (site address or directions) 19740 Scenic Drive Current Property owner(s) Bruin Builders, Inc. Day phone 5623640 Mailing address 3120 Denali Street Sulte 8 Anchorage, AK 99503 Lending agency _ Day phone Mailing address Real Estate Agent Mailing Address Unless otherwise requested HAA will be held by DSD for pickLip. 2. NUMBER OF BEDROOMS: Four 4 3. TYPE OF WATER SUPPLY. Individual Well Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Day phone TYPE OF WASTEWATER DISPOSAL: Individual On-site ' Individual Holding tank ❑ Community On-sfte ❑ 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. Certificate; of Health Authority Approval are required for the transfer of title (except.between spouses) for properties served by a single family on-site wastewater disposal and/or water supply system. DSD also issues HAAs upon request to homeowners. Certificates of Health Authority Approval are new water sample results less than, days old. (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 engineees work. 4. 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 Health Authority 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. 1 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, otdinances, and regulations In effect at the time of installation. Name of Finn Anderson Enaineedna Phone 522.7773 Address 0.0. Box 240773 Anchorage. AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 12/8/2004 4L iXs,NUNAM r x0m. 5. DSD SIGNATURE �'+ Na Cr -s= Approved for _q-_ bedrooms. ��yt Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other i' Municipality of Anchorage • �" Development Services Department Building Safety Division ° Onate Water & Wastewater Program 4700 South Bragaw St t P.O. Box 196650 Anchorage, AK 99518.6650 www.ci.anchorage.ak.us i (907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Lot 189. T15N. R1W. Section 8 Parcel ID: 051.154.28 i_ A. WELL DATA Well type Private If A, B, or C provide PWSID # Well Log (Y/N) Y Date completed 783/2004 Sanitary seal (Y/N) y Wires property protected (Y/N) Y Total depth 500 ft Cased to 84 fL Casing height (above ground) tin. FROM WELL LOG AT INSPECTION Date of test 7838004 Static water level ft ft. Well production 20 g.p.m. g.p:m. WATER SAMPLE RESULTS: Coliform _&--colonies/100 m1. Nitrate .Q mg.A. Other bacteria 0 colonies/100 ml. i Date of sampler 1288004 Collected by: TLK s B..SEPTICAHOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 5158004 Tank size 1.300 gal. Number of Compartments 2 Cieanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) N Date of pumping Pumper New Construction i C. ABSORPTION FIELD DATA Date installed &712004 Soil rating (g.p.dJe or fIz/bdrm) 8. GPD/SF System" 5 Wide Trench ii ' Length 94 fL Width 5 fL Gravel below pipe 4 ft. Total depth 10-13 ft. Eff. absorption area4�0 ftp Monitoring tube Y Depression over field hi Date of adequacy test Results (Pass/Fall) For _ bedrooms Fluid depth in absorption field before test in. Water added_ gal. New depth_ in. Elapsed Time: _ min. Final fluid depth_in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N if yes, give date Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at_ in: Datum E. SEPARATION DISTANCES "Pump off" level at _ in. Cycles tested SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot >100' Absorption field on lot >100' Public sewer main NIA High water alarm level at Meets alar 6 circuit requirements? On adjacent lots >100' On adjacent lots >100' Public sewer manhole/cleanout NIA Sewer /septic service line >25' Holding tank WA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 4 Property line >5' Absorption field >6 Water main NIA Water service line >10' Surface water >100' Wells on adjacent lots >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >id' Water main _>IT Water Service line >10' Surfacewater >100' Driveway, parking/vehicle storage >25' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS G. ENGINEER'S CERTIFICATION I certifythat f have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date Engineer's Printed Name Michael E Anderson. P.E. Date 121912004_ HAA Fee $ 5 7 S Waiver Fee $ _ Date of Payment / Z,—/ 0 — 04 Date of Payment Receipt Number Lg _m Receipt Number (Rev. 12100) AEL E. a+>M No, CE -4381 in. 11-23-2004 17:09 From -GALLERY NODES IN AJ ?1 ZD -30 /67± T-330 P.015/015 'F-779 I 1;w iE N1"" i �X3 G�rvr�ru�717i t F'/�ft,�r Dlttr►�� IF1,2 pox C. us o I G v/{� 100+1 �� J 1 tk pis W L t- L� i ! ) Sir+ JY -SZ— 7-70uti 33a,ea 1 hej@ Y certif coat a su ey of MM_ 'l _B L AMA _ITf.S...... a r7J_1= I YJ -V. AA Subdivision was made on.I AlQ! O. ,., and that the improvements situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent thereto, that no Improvements on property lying adjacent thereto encroach on the premises In question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. It is the responsibility of the owner to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. Under no circumstances should any data hereon be used for construction or for establishing boundary or fence lines. ll Dated at Anch rape, Alaska, this 1 O +-h day of - 6 r 4-110 If I. CONSTRUCTING ENGINEERS, NRS. 9601 Buddy Warner Dr. Anchorage, Alaska73,- n r fitO 34&20M a6 AS- 780167, /Z 4.-.zr .ZO� y _ '.sc�c� -1* 50 r Dec -14- 2004 1:09PM 9075226779 tL-++-O*;la+;• ;Zr •no t SGS/CTU E It". Drinking Water Analysis Repott for Total Coliform Bacteria RiADBr,,,eucstoBs oN►tevcxst:BIDEfffFORi afBWPL6 —. MUST BE C=PLr: W BY WA= SUPPLIER = OKMIUMAIM Sys" 00 TCn S.Mmo db n Swd Yn� m /�y.pM R\wJd 000vY ;150.GNo•8689 P. 2/2. = W: POTTER PRW /UJOHORAOF, AUOfA 99518 Tat W7.= -2M FsaC 907d5T•S90t ubRdNr. 1048005OPLk nom+ sAMPtE COLLECTION: �-b" JSMr. 2. 2.aw tJ �neLtme a ootbetor OBrer Q Repeat sompW 13 U.Mmstw water.. peter to bb no ' D apodal Porpor To BE CompLMD IBY LABORATORY tp(Iapb Receivhm J ppm OSamWwvr�oMen�N its RtisHLAMPjE; a mu WAY MYvao" 7ltW 04hmorw" Phsmai CeGvary 6letlw NO nunoa lr toiw Fox Received N\NN\1\M\MONo1\\OP\NNI-��Y\\.\NP\N\MNN\NMN.\N\.N\\.N\\\N\\N\\MN-b\ $g� er Dloetc-�aaAnah»N R eoed L�aAOB� . ■N�70 (PW �� ANC /BK JUN Amy\b6 s�►3Ie�F rs�so - .�'c 1bG� ecce ANDIpt AMWW MOEmd: YardetiANE rt•TfltlttSt0.':S , Q Paged C3 • TJeactCtWAt �•� Cdo�N00nA Morror a FAN vnaeo4orc "10a MMO MUIi (P!/U T\ On" IM Satisuctm ❑ umoo5tBCt" . , ace\awa.\..rre., tlsportidt3y; oatemme:N.,!�T- IZrS e,.ewa.e,w 12- t -U4: b:43VM: SGS Ref -4 1047815001 Client Name Anderson Engineering Project Name/# Lot 189 T15N R1 W SS Client Sample ID Lot 189 TI5N RI W SS Matrix Drinking Water :9U7 5616301 All DatesMates ere Alaska Standard Time Printed Date/time 12107/2004 14:34 Collected Date/Time 12/02/2004 11:50 Received Date/Time 12/02/2 4 13:00 Technical Director`�� Step Ede Released y/�/T # 2/ 6 Sample Remarks: Parameter Results Allowable Prep Analyse PQL Units Method Container lD Limits Date Date Init Waters Department Nitrate -N 0.110 0.100 mg/L EPA 300.0 B («10) 12/02/04 BJA I Ccrobiology Laboratory Total Coliform 54 OB, No Coli coV100mL SM20 9222E A (<=I) SM -Z Lx i7 12/02/04 DPT