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Home My WebLink AboutMOUNTAIN PARK ESTATES BLK 6 LT 4Mountain Park Estates Block 6 Lot 4 #017-391-07 Municipality of Anchorage On -Site Water and Wastewater Program ° (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP191177 PID Number: 017-391-07 Dwelling: ❑■ Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New ❑■ Upgrade Name: Warren Horowitz & Nancy Simel ABSORPTION FIELD ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound Address 13050 Ridgeview Drive, Anchorage, AK 99516 ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 240-9423 3 Existin GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot Mountain Park Estates 6 4 Fill added above original grade Ft. Gravel length Ft. Township Range Section Gravel width Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line Ftz Ft. Well >100' N/A N/A NSA >25 TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Infiltrator Capacity 11,060 Gal. Surface Water >100' N/A N/A N/A Material Number of compartments Lot Line >5' N/A N/A N/A Plastic 2 NA Foundation >10' N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain None Noted Gal. Remarks 2 Insulation over tank. Pump on level at in. Pump off level at in. High water alarm at in. Tank only placed under this permit. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank D3034 Tank to drainfield D3034 Isaacs Excavating Drainfield Existlnq CO/MT Inspector J. Millette BENCH MARK (Assumed elevation) 100 ft Inspeection 151 5/28/19 ntl Location and description 2 3 r 4'h Bottom of siding on NW corner of house. COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp OF Conditional Approval: Date ��P.=...............••��®� 49th •.. 1: .vn.. ue....navvaer my ... �.v ve............... .v........................ ® , MICHAEL E. ANDERSON e w a' IMM c. No. CE -4381 ,` � a �F 10/31/19 9°�� FO °`••••au.a>yO°°`�� Approved Date 11 1 1 I ®� m5pecoon mepori_y- i- i z.aoc MOUNTAIN PARK ESTATES, BLOCK 6 LOT 4 PERMIT # OSP191177 PID # 017-391-07 NEW 1,060 -GALLON I PLASTIC SEPTIC TANK w/ 20" MANWAY \ EXISTING WELL / �� OLDEN D CHAIN LINK FENCE / i \ 'G �MH 2C0 � � M•T � / A B LOT 3 DECK 3-BDRM HOME G) 100' WELL RADII LOT 4 = I I EXISTING WELLS SHED 49th T•. MICHAEL •E, ANDERSON ' ". No. CE -4387 ,,••�� 10/31 /19 ,,,�,.•'•��® • ■LA�AS-BUILT 1 50 100 km m . �E. .:� FEET111=50' A B MH 22.5 21.0 SV 23.8 18.3 MT 21.3 15.8 2CO 25.4 17.3 I I66 I NEW 1,060 -GALLON I PLASTIC SEPTIC TANK w/ 20" MANWAY \ EXISTING WELL / �� OLDEN D CHAIN LINK FENCE / i \ 'G �MH 2C0 � � M•T � / A B LOT 3 DECK 3-BDRM HOME G) 100' WELL RADII LOT 4 = I I EXISTING WELLS SHED 49th T•. MICHAEL •E, ANDERSON ' ". No. CE -4387 ,,••�� 10/31 /19 ,,,�,.•'•��® • ■LA�AS-BUILT 1 50 100 km m . �E. .:� FEET111=50' A B MH 22.5 21.0 SV 23.8 18.3 MT 21.3 15.8 2CO 25.4 17.3 LEGEND CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEAN( FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH -TEST HOLE MOUNTAIN PARK ESTATES, BLOCK 6 LOT 4 ENGINEERING PID # 017-391-07 PROFILE AS -BUILT (NO SCALE) 2" INSULATION c: 49 TH `9 h'Ae�— 0 s SHANE A. HOLT �� G LS -6914 y��4� ,\,°fessiona� �Qo DRIVE -_` �i O THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY 1" =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT 4, BLOCK6, MOUNTA IN PA RK ES TA TES ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 11TH DAY OF NOVEMBER , 2019 14201 FB 196-9,201-49 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: 0SP191177. Work Type: SepficTank Upgrade Tax Code Number: 01739107000 Site Legal Address: MOUNTAIN PARK ESTATES BLK 6 LT 4 G:2838 Site Mailing Address: 13050 RIDGEVIEW DR, Anchorage Owner: HOROWITZ WARREN L & Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft Total Bedrooms: 5/16/2019 5/15/2020 26100 ❑ Disposal Field 2 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15; a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: 5 Issued By: Date: �6 3 MUNICIPALITY OF ANCHORAGE 0w Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 017-391-07 Property owner(s) Warren Horowitz & Nancy Simel Day phone 240-9423 Mailing address 13050 Ridgeview Drive, Anchorage, AK 99516 Site address 13050 Ridgeview Drive Legal description (Sub'd., Block & Lot) Mountain Park Estates, Block 6 Lot 4 Legal description (Township, Range & Section) Lot Size 26,100 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (M all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑X (w/wo ADU) Holding Tank ❑ RenewalDuplex ❑ (D) ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: '� 26 Waiver Fees: _ Date of Payment: 5-11311t9 Date of Payment: Receipt Number: 0-6-965-Z _ Receipt Number: Permit No. CJ S 01!9 1( -71�- Waiver No. Permit App_-'- : - :-'._c May 16, 2019 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 5/16/19 Subject: Mountain Park Estates, Block 6 Lot 4 Septic tank replacement Dear On-Site Services Engineer: The septic tank on the above lot is 37 years old, and the owner has decided to replace it. The existing home is a 3-bedroom. We are submitting this permit application for the placement of a new septic tank. The attached site plan identifies the location of the existing home, well and septic system, as well as the location of the new septic tank. The drainage pattern in general will not be changed by the construction. The existing 1000-gallon tank will be pumped dry and decommissioned per code. The new tank will then be placed outside the 100’ well radius and 10’ away from the foundation of the home. After the new tank, we will install a double-cleanout and connect into the existing absorption bed. If installation is performed according to these plans, there will be no adverse impacts to adjacent properties. Sincerely, Benjamin Schiller, PE Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191177, Rebecca Carroll, 05/16/19 // // // // // // // // // // // // // // // // // // // // // // // // //10050 0 FEET 1"=50' NOTE: ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE SHOWN. NO CONFLICTS WITH WELLS OR SEPTIC SYSTEMS.CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND MOUNTAIN PARK ESTATES, BLOCK 6 LOT 4 May 16, 2019 HOLDEN DRIVE RIDGEVIEW DRIVESHED 10' UTILITY EASEMENT DECK 3-BDRM HOME CHAIN LINK FENCE DECOMMISSION EXISTING 1000-GAL SEPTIC TANK INSTALL NEW 1000-GAL SEPTIC TANK W/20" MIN MANWAY RISER TO FIRST COMPARTMENT OF TANK INSTALL DOUBLE CLEANOUT AFTER TANK MAINTAIN 5' MIN SEPARATION TO PROPERTY LINE 8.0 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP191177, Rebecca Carroll, 05/16/19 c: 49 TH `9 h'Ae�— 0 s SHANE A. HOLT �� G LS -6914 y��4� ,\,°fessiona� �Qo 0 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS; AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT , ARE NOT SHOWN HEREON ( UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY 1" =30' NO CORNERS SET THIS DATE I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY OF THE FOLLOWING DESCRIBED PROPERTY LOT41 BLOCK6 MOUNTAIN PARK ESTATES ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS EXIST OTHER THAN NOTED. DATED AT ANCHORAGE, ALASKA THIS 76 TH DAY OF APRIL , 2019 14201 FB 196-9 HOLT LAND SURVEYING 9309 GROVER DRIVE ANCHORAGE,AK 99507 345-5513 \ MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 1 ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 \ ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONErya NEW / C �J If c�V/-7 1,1 Z¢3_55% ❑UPGRADE MAILING ADDRESS Z de -Sf. 59So -2- LEGAL DESCRIPTION LEGAL Lor e .cloak' 4, LOCATION r NO.OF BEDROOMS � Gwa o�'7F' Tia 3 DISTANCE TO: Well Absorption area Dwelling PERMIT NO. O .Y w 2 N Manufacturer GrGGr Tan/C Material Z;7,l, No, of tom ert� eLments Liq. capacity in gallons lylew IF HOMEMADE: Inside length Width Liquid depth 6 Y DISTANCE TO: Well _ t� Dwelling PERMIT NO. —10 Z Z? F 7�irla^ Liquid capacity ingallons Manufacturer Material DISTANCE TO:%� Foundation - Nearest lot line i PEHMI�.1 O. w= ELength GO ii Z F= ¢ No. of lines z o each line � #._ZD Total length —ofliline 9 i_ ¢ �% Trench width .ir inches Distance between lines lines... h- Top of tile to finish grade Material beneath rile Total effective absorption area O inches 755 •S,x=' Length Width Depth PERMIT NO. W l7 At f Type of crib Crib diameter Crib depth Total effective absorption area LuLu w DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation w Seer line Septic tank Absorption area(s) OTHER PIPE MATERIA jJvt J G ioy Olusa VL, T PYA o1 e,, SOIL TEST RATING 250 S4fi' .CSQ INSTALLER C �iEXG2✓aTi� �••� T ,� OAZA .v T REMARKS T I a, C a A7jOT A i •'•.¢9 1 �I her' •�<'"t'?� /•1•�• •N•N•NN • •A ' NNHN • .H� .f/ MUNICIPALITY Join" 6'sa d'Ile A? C11GRAGE 'i j DEPT. O. 1 :P.L R ROFESS 1C APPHOV ED CAT E C EV 72-013 (Rev. 3178) rlUr-a I �_ I F'!_!L I -Ir 'T OF Fr4CH+_lF'F!C�E DEPARTPIENT f"',, HEALTH AND ENVIRONPIENTAL/-'OTECTION 825 STREET, ANCHORAGE, AK. 9_ . Z+1 264-4720 lzlr-!—� I TE E1JEF' F'EF'r1 I T PERMIT NO. C 820540 ) APPLICANT CR:J EXCAVATING 8620 JADE ST 2435547 LOCATION RIDGEVIEW OFF DEAP.MOUND LEGAL L4 B6 MT PARE; EST *% LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING CSD FT/EP)= 250 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C�EF•TH= 1a LE"GTH= 15 -el GF'!=IVEL OEF'TH= THE LENGTH DIPlENSIO14 IS THE LENGTH CIN FEET) OF THE TRENCH OR: DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOP: TRENCHES THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION CIN FEET). F'Er!lJ I F'EC= EF'T I C T1ir-4F � I `E= 1C-s'D[D GFiLLnrl•= PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTION'= OF ANY WELLS ADJACENT TO THIS P'ROPER'TY AND THE NUMBER OF PESIDENCES THAT THE WELL WILL SERVE. --- Tt,lr► r `? I rA F'ECDT I iCl"a — AF'E F'EG!U I F'EG* --- BAa'FILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIPIUPI DISTANCE BETWEEN A HELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC 14ELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIPIUPI DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEHEP LIWE IS 25 FEET AND TO A COMMUNITY SEWER LIWE IS 75 FEET. - OTHER REQUIREMENTS MAY APPLY. SPECIFICATION'S AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F'EF'11-1 I T Z:7:3-, 1!F+:E* 2� I CERTIFY THAT 1: I AM FAMILIAR WITH THE R:EQUIR:EMENTS FOR ON-SITE SEWERS AND I -JELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I I•JILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED jP-i-tICLUDE MORE THAN 3 BEDROOM'S. APPLICANT CB:J _r: 'A'JRTIPU3 ISSUED BY__ - -- _-._ __---- _ --DAT V4. 0 "11 r� r JX SOILS LOG �t MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION X PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 - /1 L / 1— SOILS LOG - PERCOLATION TEST PERFORMED FOR: ef..4/��'i DATE PERFORMED: --& LEGAL DESCRIPTION: LOT a 4e �I,� (D 1 2 t L Gross <, / 3 0 4 Drop 5 ;A i a. a 13- 14- 15 3 14 15 16- 17- 18- 191 6 171819 20 COMM t/ci.» ci3 .1"'I/ 3"m�nNs 5il><y 6.-av6A Sand W/paw 4/nota / /oM Codd/y 1-eddi3lj �a�,o� I 1 1 1 I I I I I I I I I I I I lid 60 71rzo�y /Z �7F'r,� SM WAS GROUND WATER ... S A6 ENCOUNTERED? L O P IF YES, AT WHAT E DEPTH? Jualft L Roberts *6 32lOi Al le- I Reading Date Gross Net Depth to Net Time Time Water Drop 3iCIA A/z/ 4:' t2 /`1e14 / i t.%/c.11o /2 j lei 6af .y.r . / ,� i PERCOLATION RATE iminutes/inch) TEST RUN BETWEEN FT AND . 9 FT PERFORMED BY: �(� CERTIFIED 72.008 (6/79) -------------- - _ ---- C a N - -b �q- ----- \ v\%� Q\ (t v-iVl, SS onittuctlon E7esf 1'u✓ "One tort is worth. thousand opinions" 2204 Cleveland Anchorage, Alaska 99503- Performed 9503Performed For Don Webster Date Performed 6/17/77 Legal oescrintion: Lot 4 Block 6 Subdivision mt. Park Estates This Form Reports Soils Lon ves Percolation Test_ yes Peoth Feet Sai 2 Brown Silty Sandy Gravel 4- 6- 8 Brown Sandy Silt, with 10 — occasional Gravel 12- 2- 14- 14- 16 16 Bottom of Test Hole 16 — 20— Was Ground Water Encountered? No If ves, At what Depth? s tlM�lA'��_ •1 U r4 10- P`z R L I T'4' ED F Fi r-.! (-_ F: Fi C3 E DEPARTMENT HEALTH AND ENVIRONMENTAL r'OTECTION • 825 'L' STREET, ANCHORAGE, AL;. 99501 264-4720 I,IE=LL f�'ER'C'1 I T PERMIT NO. C 1020543 APPLICANT ALASKA BUILDING LOCATION LEGAL 1_466 MT PK EST SFA 413E 99507 345-6127 LOT SIZE 999999 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC I•JELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER: LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIP.ED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER: REQUIREMENTS MAY APPLY. SPECIFICATION'= AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER: INSTALLATION. F'ERh'1 I T'- E}FIRES C-E:(Er'IE EF: 31 1lp:s I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIPEMENTS FOP.. ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTPLL.4THE SYSTEM„IN ACCORDANCE WITH THE CODES. S I GPJED : _4A4__, AFF'L�bJ ISSUED BY 1_1 BUILDING i J _a e-_> — V4. 0 n M -W DRILLING, Inc. .. P.O. Box 10-378 • 10300 Old Seward Highway • (907) 3438535 ANCHORAGE, ALASKA 99511 DRILLING LOG Well Owner Gnrth Merrill_ Use of Well Do' -'#"3 d r Location (address of: Township, Range, Section, if known; or distance main road Tnt 1, Alnnk 6 Mmintain Park Fotntes Size of casing LI Depth of Hole --= feet Cased to 9M 1 feet Static water level 17 5 ft. (aboes) (below) land surface. Finish of well (check one) open end ( x ); Screen ( ); Perforated Describe screen or perforation f1j(1� Well pumping test at -10 -gallons per S(bn=) (minute) for -1 --hours with 100% ff: of drawdown from'static level. Date of completion_Jvno 1^, C WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness 0 TO 2 Casing Stick -un TO 182 Sandy hnrd rnn - U20 0 'k GPM 2 2 Siltv sand TO 0 20 TO 140 ` Silty snndy Fravel 140 TO 180 Silty sandy gravel 180 TO 182 Sandy hnrd rnn - U20 0 'k GPM 182. TO 196 liardrpan.. silty - 196 TO 202 11�dy^Travel TO TO _ TO TO TO —TO- 0— OO TO r..,,•r., .�. AL1 ,+ Irr . 3 — CONT RACTO J MUNICIPALITY OF ANCHORAGE Department of Health &Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # n1`1 ,�)q ( — n -A HAA # '1A fn t _"d1q 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) 1 -of 6(ock o; rfccP;4,6n Park Elia. er # 1 Location (address or directions) 1305'0 61dutv4ew Or: (b) Property owner CbmAX Pr5r40 Telephone: (home) 333 -6033 Business Mailing Address _1826. - 3 2Y'r" five NB r P.0.6ox 169 _ Cr arnal�� WA 9601Y (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent —200 I R eulfr - SSuro'l Coil et Address 13 YS u/ 9i9� Anc-beng P, /Itc 99SC7 Telephone (e) Mail the HAA to the following address: (or check here lg if hold for pick up.) List contact person and day phone number below: Zia r1 o -c 3Ys-- 13S-3- 5urae 62M 4 to e It Z 76- Zoo/ .Ter; Dlinrnry 2. TYPE OF RESIDENCE Single -Family IR Number of bedrooms 3 3. WATER SUPPLY Individual Well tB Community ❑ Public ❑ .—Note: If community well system, -must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site % 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. 72-025 (Rw. 7/E8) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION Ascertified by myseal affixed heretoand asof thevalidation dateshown below, I verifythat myinvestigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the Information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm F/a fL54 7:`K ? t'ta/ Svcs Telephone 311yr-13SS— Address /1/5-30 EC%7o rA A,7ctiorcx9P. fly Date 4Q2? -o1 1; 199/ , y.�...'/......................r 0.1 .... ......> .. .Q � Engineer'sSeal ^T:;ZOrO:;c- F. 1.7oCRE m CE - 35.".9 •o' O y� : X14U 4 a p izo 6. DHHS APPROVAL / Approved for�4 edrooms by &�,,�A4-Z`,,_jr Date ApprovedDisapproved Conditional Terms of Conditional Approval CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. Employeesof 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. 77025 (Rev, 7/881 B.ce Pace 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) • ^� Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984t'q� 343-4744 ,QAR+.-. Legal Description: C k un in ctrl; # 1 A. WELL DATA CD Well Classification Pri-ufIf A, B. C, D.E.C. Approved (Y/N) N.A. Well Log Present (Y/N) i Date Completed 6 16 2 Yield ?. 0 Vn m Cal I/zs%91 Total Depth202 Cased to 202 Depth of Grouting N,4 Static Water Level 1701 Pump Set At x Vol Casing Height Above Ground PO �� Sanitary Seal on Casing (Y/N) r Electrical Wiring in Conduit (Y/N) Y Depression Around Wellhead (Y/N) N SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot -- 10'y' % c.o. ; On Adjoining Lots fly To Nearest Edge of Absorption Field on Lot ^ -IIo' ; On Adjoining Lots ;t 100' To Nearest Public Sewer Line N, A• To Nearest Public Sewer Cleanout/Manhole AI• A To Nearest Sewer Service Line on Lot ---&y' Water Sample Collected by _F7WI642 Tech C(lex ; Date - I / ZS / 9 I Water Sample Test Results-S�tLUC«ckry — 0 Cand(orn 1100M AXt Zee Le litAmle— N Comments ' B. SEPTIC/HOLDING TANK DATA Date Installed 716 2 Size0l 00 No. of Compartments 2 Standpipes (Y/N) t Air -tight Caps (Y/N) '" Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped I/24-/91 6 y .Tsaac r Pumping/Maintenance Contact on File (Y/N) N, A. ; for N. 4. Holding Tank High -Water Alarm (Y/N) N. I Temporary Holding Tank Permit (Y/N) All R SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 10`4 1 _rraa C.C.. To Building Foundation l6' To Property Line 20 To Disposal Field to, To Water Main/Service Line 60 ' To Stream, Pond, Lake or Major Drainage Course :P, 100 ' Comments 77-026(R". 7/88)Fro l Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Aps rY tion Strata 250 0 /6dr n Type of System Design _T en ch Date Installed"4 -7/6 2 Length of Field -- — > 9, Ito M ,,,`W0f�6f Field0�28 Depth of Field 12/ Gravel Bed Thickness -- '91 Square Fe gl� �kb`Sortion Area 75 -Y At' IC • reA. Statndpipes Present (Y/N) Y Depre�2 pMr Field (Y/N) N Date of Last Adequacy Test 112s/91 Results of Last Adequacy Test hdeouufe .4�, r 3 6 edroor./ SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well / (0 To Property Line It a Per 1W. report To Building Foundation /ti/ —gip• Wc%-t To Existing or Abandoned System on Lot IU, On Adjoining Lots '�- 36 I To Water Main/Service Line 6S I To Cutback (if present) No R. To Stream, Pond, Lake, or Major Drainage Course (00 I To Driveway, Parking Area, or Vehicle Storage Area 2 21 Comments SYt%em aretoul-reeL w. 22.60 eff Yf o ni;oe 747 s7F7/-t of d uuc D. LIFT STATION M• A. l7—r{�Q l 1, .n "�� Date InstalledDimensions J�l<%' U Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent(Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request" ♦gCgQ I certify that I have checked, verified, or conformed to all MOA and Ii 14 effect on the date of this inspection. o 'L 4....••• . p Signed T. Mc�- Company Elu�'p RcAWICa/ Serv/65-f Date _Y///f/ MOA No. - 90 —0/9 Receipt No. Date of Payment Amount: $ /%0 0 72-M8 (R". 7/E8) Beck Receipt No. Waiver Fee: $ _ Date of Payment Page 2 of 2 Engineer's Seal `�YYC�nStSVJ� Time APPLIr NT FILLS OUT UPPER WA ) ONLY PropertyOwner .�.r-N (RILL Phone Mailing Address 4 — C Zip Code S0 pis -Gra Buyer q Address Zip Code Date Lending institution Phone Address t Zip Code Realty Co. & Agent Phone Address Zip Code Inspector Legal Description 6o p—�1 b i� (j Al f x'444 InspectorInspector t. Street Location 07 Type of Residence .Q Single Family ❑ Multiple Family No. of Bedrooms t'1. ❑ Other Field Notes: Water Supply U q,!I ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ,P12—Individual ❑ Community - [ r/ R.0 For wells drilled prior to that date, give well depth (attach log If available). Public Utility RECEIVED ( 3) APPROVED BEDROOMS Sewer Disposal ndividual ff11 X aU c� 40 Year Individual Installed: �i❑Public Utility n , When Connected to Public Utility: ❑ Holding Tank DATE 1 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. `�YYC�nStSVJ� Time Time Time Time eA1��rP Date Date Dare Date F1\ Inspector Inspector InspectorInspector Plce- ,,,.�,_`1 t'1. Field Notes: MUNI rr. P• - d'" RECEIVED ( 3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' DATE 1 BY: Soils Ratlnp Date Sewer Installed Well To Absorption Area ? ( 6 Well Log Received ^n Well to Tank 10Z. Septic Tank SIZe 720 0`en