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T15N R1W SEC 8 LT 189
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
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1589'52'27'W 330.04 (Neo&) (79-130)
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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,
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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
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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
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8-
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10
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12
13
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15
16
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SLOPE
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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)
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WAS GROUND WATER 00
ENCOUNTERED?
S
IF YES, AT WHAT LO ✓
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E
lisp@ Wl�(et,
Manlloritinp? ` Batt
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L_J PERCOLATION RATE (minutevmeh) PERC HOLE DIAMETER
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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)
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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.
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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
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1 hej@ Y certif coat a su ey of MM_ 'l _B L AMA
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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
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34&20M a6 AS- 780167, /Z 4.-.zr
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Dec -14- 2004 1:09PM 9075226779
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Drinking Water Analysis Repott for Total Coliform Bacteria
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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