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Home My WebLink AboutPARK HILLS #1 BLK 2 LT 13Park Hills #1 Block 2 Lot 13 #017-112-57 -� Municipality of Anchorage ., Development Services Department Building Safety Division On-Site Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Pogo 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number. SWO50268 PID Number. 017-112-57 Name: BRAD EVANS Wastewater System: ❑ New ❑ Upgrade Address: 14741 PARKHILL CIRCLE a ANCHORAGE. AK. 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 344-5222 4 ODeep Trench OShollor Trench ClBed OYound 0Other LEGAL DESCRIPTION sail Raw°, Total a.pth nam origins yrs : CPD/sq. R R Block: Lot: Subdivision: D.pth to Pipe Colton from o40" erode: Drawl eepth perroU F 2 13 PARK HILLS #1 R R Township Range- Section: rsl Waal above "Imfl ql e : WELL: ❑ New ❑ Upgrade Ora.el wath: Nu of Rner. 0inanee bet~ Wree: R R Cbsrlicotq (Pri.ote. A.B.C): Tota Wpm Cases To: a ) Total obeorplion area: Pipe nptNiol: R 5a. R OwW �1`1 ,Wd: Static Wat.f IA.eI: Inelolen EG/OWENS EXC. ante k4talw: R n.ld: Puna Se AC Cerra NrSM ADew Geund: 1�/ O fj.-' � G^ TANK spy n, R SEPARATION DISTANCES (10Holding ■S.T.E.P. Cl Other .I ,aseptic TO Septic Absorption Lift '� '-/folding"' P„Clk lvgt* S.ner lanes Yorwloctwr. ANCHORAGE TANK Capaaly in eoYon.: 1500 rrom Tank Field Station Tonk Well - - too'+ - ,25'+ Material:/lvrnaer a, STEEL of eonporl nents, 2 Surface water — — 100•+ — — LIFT STATION Lot Line — — 10'+ ...�,',.� ... 11�.. �t� sits W gosoee: - 1500 Ylorwloctm. ANCHORAGE TANK 10'+ 'F;; Pan wv at: p of l.ar at: Kan aatr otnn ol: Foundation — — — — 42" 42" 46" Curtain Drain — — N/A _ — P." yaw e: ".I. oecuica lne tions Warned by; /20 OSI 05 HHrI RISING SON ELECTRIC INC. Remarks: BENCH MARK lsea4on ana G.eMtion: *THE OLD S.T.E.P. TANK WAS COMPLETELY BOTTOM OF SIDING AT SIDEWALK ON SOUTHEAST ABANDOND PER UPC. SIDE OF HOUSE **REPLACEMENT OF OLD S.T.E.P. TANK Aeeumed O.wuon: 103.26 R ENGINEE SSEAL � o Inspections performed by: GEG, Ltd. Dates: 1st 8/26/2005 r- ..... . ..................... 0 2nd 8/26/2005 0 3rd 8/26/2005 Q4p ffre Garness.: 0 Development Services Department Approval Q : ., CE-79 3 `Fpp • • F� l �6�� Reviewed and approved by Date:Y'04p°p^ate Q!°^e 6c�o oreeeta^° (Rev. 12/01) 04OOQ��O PERMITNUMBER: AS -BUILT DRAWING Pte'' 1 "-5 SW0 - SW050268 017-112-577 A B NST1 15.60 18.70 ST2 20.20 25.90 MH 21.70 28.00 SURFACE WATER DM CURTAIN DRAM / OUTFALL / DRAINFIELD 1 / �NRp4 BED p1A I 1 1 \ / `tEb• / NEW \ 1500 CALLON STEP. TANK GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 3 GENERAL CONTRACTORS =I L V. MVA • 101 • M MOVAL Mf MO) • MEI[ (10!)1))-0177 • M[ MorA� • �Oi1C wtr�ryr I PREPARED FOR: PHONE NUMBER: PACE NUMBER: BRAD EVANS (9D7)344-5222 2 OF 3 LEGAL DESCRIPDON: DRAWN BY: PARK HILLS SUBDIVISION #1; LOT 13, BLOCK 2, R.A.L. TYPE OF WORK: DATE: AS -BUILT FOR NEW S.T.E.P. TANK 8/30/2005 nw. almi PIMUrTSW0 NI268 AS -BUILT DRAWING P017 � NOME" SW050268 017-112-57 nNAL CRADE 100.10-100.91 r2• INSULATION TOP OF TANK AT INLET - 97. INVERT of BUNDI I NEW 1500 GALLON AT INLM - 98.94S.T.E.P. TANK GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS i GENERAL CONTRACTORS .m) L w OVA tint IM • MCKMOL M rem • e IMVAV lft • M (mya yr • �c ....,.�... PREPARED FOR: PHONE NUMBER: PAGE NUMBER: BRAD EVANS (907)344-5222 3 OF 3 LEGAL DESCRIPTION: DRAWN BY: PARK HILLS SUBDIVISION #1: LOT 13. BLOCK 2. R.A.L. TYPE OF WORK: DATE: PROFILE AS—BUILT FOR NEW S.T.E.P. TANK 8/30/20 pw. Ulm) TOP OF TANK OUTLET - 97.50 UN N: Rising Son Electric Inc. on ■ 907 522 6777 09/07/05 08:53A P.001 1 l', 6�7 Rising Son Eleclric, Inc. 14916 \Voodland Drive >f Eagle River. AIV 99577 (947) 622-6777 September 7, 2005 Gamess Engineering Group 3701 E. Tudor Road, Ste. #130 Anchorage, AK 99507 Re: Lot 13 Block 2 Parkhill #1-14741 Parkhill Circle Dear Kelly: The lift station at the above referenced property has been wired in accordance with NEC and State/Local codes. Thank you. Sincerely, C%ia. c w Kevin t. Hombuckle, Owner Administrator License Number 1284 Specialty Contractor License Number 27285 , 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 WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Aug 05, 2005 Expiration Date: Aug 05, 2006 Permit Number: SWO50268 Parcel ID: 017-112-57 Legal Description: PARK HILLS #1 BLK 2 LT 13 Design Engineer: 0855 Garness Engineering Group, LTD Site Address: 014741 PARK HILLS CIR Owner Name: BRAD EVANS Lot Size: 48339 SQ. FT. Owner Address: 14741 PARK HILLS CIRCLE Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE. AK 99516-4246 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked 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. Received By. Issued By: Date: Municipality of Anchorage • J Development Services Department Building Safety Division On Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.enchorage.ak.us (907)343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 ? — / 1P _'57 Permit Number Property owner(s) GRAD EVANS Day phone 344-5222 Mailing address (1) 14741 PARK HILL CIRCLE • ANCHORAGE. AK. Mailing address (2) Legal description (Section, Township & Range) _N/A Lot Size g k�33� Acree THIS APPLICATION IS FOR: Zip Code 99516 Number of Bedrooms 4 Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ certify that the above information is correct. 1 further certify that this application is being made fora Single Family Dwelling and Is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP, Ltd. Permit Fees: tD Date of Payment: B �S Receipt Number: Waiver Fees, Date of Payment: Receipt Number. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS 3 GENERAL CONTRACTORS August 1, 2005 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bmgraw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: S.T.E.P Tank Upgrade for Park Hills Subdivision #1; Lot 13, Block 2, To whom it may concern: A documented 1500 -gallon S.T.E.P. tank currently serves the existing 4 -bedroom house. The tank is structurally unsound and taking on groundwater. We are proposing that the existing 1500 - gallon S.T.E.P. tank be abandoned per UPC code, and a new 1500 -gallon S.T.E.P. tank be installed in accordance with the Municipal standards. There are no surface waters within 100 feet of the proposed upgrade. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. .E., M.S. NOTE: Attached is a site plan drawing, and a design drawing, which are all part of the design package for this septic system. (Contact G.E.C. Ltd. for Spage construction specification letter.) 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: gamessengineering.com LOT 1, BLOCK 3 PARK HILLS 5/0 /1 I I 1 I I I I I 1 I I I 1 I }• LOT 16. BLOCK 2 y� PARK HILLS S/D /1 1 ELI", �- -\\\ /1 \ CON / SURF/ FROM CI A', 11 LOT 14, BLOCK 2 PARK HILLS S/D /1 / / I I / \ - - - - - - � - - \ L - \ EXISTING \ -4BEDROOM I N I LOT 1 PARK HILLS RIDGE S/D I i //PARK 17, BLOCK 2 / PARK WLLS S/D /1 \ /] I WATER T/I WATER ♦ I WN DRAIN / / / 11 11 '• L I 11 it LAT 12. BLACK 2 \ 11 11 \PARK HILLS S/D /1 \\ / \\ G\\ \ PROPOSED \ SEPTIC SYSTEM \ j S.T_EP. TANK ----- - I r ------------ I I I TRACT B I PARK HILLS S/D /1 I I I I I I O GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS& GENERAL CONTRACTORS •••• ••• •• •• I L MW I M[ 101 • MIUORVE W M001 .MOW • M M WNM •w 2EPARED FOR: PHONE NUMBER: PAGE NUMBER: .. 0••.. _ ..... ........... If A. mess. BRAD EVANS (907)344-5222 1 OF 2 p . DRAWN BY: ��° • CE— 43:GAL DESCRIPTION: •` PARK HILLS SUBDIVISION #1: LOT 13. BLOCK 2. R.A.L 4 '' z 'v($6 PE OF WORK DATE 4 QDOppOo` SITE PLAN FOR PROPOSED S.T.E.P. TANK UPGRADE 8/1/2005 (RH.olm) NOTE: THE CONTRACTOR SHALL HAVE THE 100' SETBACK FROM THE STREAM THAT RUNS ALONG THE SOUTH PROPERTY UNE FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO \ i:T. \ i LETTER THAT PERTAINS TO THIS DESIGN. \ TO OBTAIN A COPY OF THE LETTER CONTACT GEG. BY PROCEEDING FORWARD \ +' WITH THIS INSTALLATION, THE ENGINEER, WELL DRILLER, CONTRACTOR AND —� PROPERTY OWNER AGREE THAT THEY••• HAVE READ THESE SPECWICATWNS AND \ t•�' AGREE TO ACCEPT THE TERMS AND CONOMONS OUTLINED,\'^L• 4 'e� I \\ ••4 I I.J I CURTAIN DRAIN OUTFALL PROPOSED ISM GALLON S.T.EP. TANK II II EXISTING lsool I GALLON S.T.EP. TANK TO BEI I COMPLETELY I 1 ABANDONND• PER\ Upc I I I II I II I II 1 GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS i GENERAL CONTRACTORS =1 L TAW WA YR 101 • MOO VAL M OM01 •11101[ 1 -GIT RA (Wr'M X" • ANA PREPARED FOR PHONE NUMBER: PACE NUMBER: BRAD EVANS (907)344-5222 1 OF 2 LEGAL DESCRIPTION: DRAWN Bf: PARK HILLS SUBDIVISION #1: LOT 13, BLOCK 2, R.A.L. TYPE OF WORK: DATE: DESIGN FOR PROPOSED S.T.E.P. TANK UPGRADE 8/1/2005 (RN.01m) RECEIVED APR 121993 STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES DIVISION OF WATER WATER WELL RECORD �,' •lR LOGAI IUN Ur "LLL TOWNSHIP , MERIDIAN BOROUGH SUBDIVISION LOTP 8�3� 1 Hurr �(v�rf�ys SECTION ❑E I� ❑S ❑W ,n LOCATION/SKETCH: WELL OWNER: MEASURED FROM:❑casing top ❑ground surface WELL D DATE OF COMPLETION DEPTHS Depth of hole: /ii/ it G / it BOREHOLE DATA: Depth Depth of casing: / of Material Type and Color From To DEPTH TO STATIC WATER LEVEL: t below estop of casing' ❑ground surface Date: z_I :2 11� Odt/ raj / METHOD OF DRILLING: Pair rotary ❑ cable tool ❑ other USE OF WELL: ,ET domestic ❑irrigation ❑monitor . i I ( N l ❑ public supply ❑ other CASING STICK-UP: ft. Diam: (Iin. tofaLft Casing type: _(2__in. to ini ft WELL INTAKE OPENING TYPE: G open end ❑ screened r ,.. Q �4 R ❑ perforated ❑ open hole Depths of openings: to it SCREEN TYPE: Diam: in. SlotlMesh Size: T Length: ft CRAVEL PACK TYPE\ Volume used: Depth to top: l GROUT TYPE: '-� Volume: Depth: from into ft RE DEVELOPMENT METH D: Duration: APR 2 PUMPING LEVEL AND YIELD: hrs �/9 nC Ora9e ft after __ pumping gpm u &Noma PUMP INTAKE DEPTH: ft Horsepower: pept.Health WELL DISINFECTED UPON COMPLETION? B YES ❑ NO CONTRACTOR INFORMATION: REMARKS: egistere0 Business Name PLEASE MAIL WHITE COPY OF LOG TO: 17 ,--r�t-n�-r, ILL -r- -!1 ?j DNR/DIVISION OF WATER S,`gnature of Authorized es resent' rve Dam PO BOX 772116 EAGLE RIVER AK 99577-2116 PAGE 1 OF MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL SYSTEM PERMIT PERMIT NUMBER:SW930034 DATE ISSUED: 3/23/93 DESIGN ENGINEER:DUMMY COMPANY EXPIRATION DATE: 3/23/94 OWNER NAME:REED JEFFREY N & REBA D OWNER ADDRESS:1630 EAST RIDGE DR. #204 ANCHORAGE, AK 99501 PARCEL ID:01711257 LEGAL DESCRIPTION: PARK HILLS #1 BLK 2 LT 13 LOT SIZE: 48339 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: WELL SYSTEM 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PR' RECEIVED B ISSUED BY: DATE. "23-913 DATE: y 1 OJa— lo) / N 'Fov.+v Z 'ie Run. a rO0 rr �' 307.$'. oyyjK��y��3z.zs I �c A1.J✓ "r /4- def TIC d ✓Cn— toof Lot 11 3N �Ie, o v "A', loo Ar A l r Li LvtA'SCMC. ?A'TW,. it lat-cz• MMdmr,97 — '�--Fov+o S/+b"Rrr�.n. N89=53'•50 \/ACA,vt 1'OreALT G PLOT PLAN AS BUILT X SCALE V' 40 I po��o 1�8 RrM.n.. Caster fliNso' Wean Vnae✓r ear GRID 3131 JOB No91•ROD ®lSI1LYS®��ja [:l)L fllCYSg)LOS 1731 George Bell Circle �;,,•., , LYS Ctrs Q o Anchorage, Alaska 99515 ((9O2Y'T%g4T4 V'% ' r I Hereby certify that I Lava surveyed the following described prop arty: p C. "• • • • r Lot I'i .1 ID& 'L A PAK.K F}I I.LS 41f�[�,VIS��A1 ACO. Noy'. J A� .' c � •. }'• 0 ANu1olt.nUte Recording District, Alaska, and Nat the fmpr temente situated thereon are x�:• (� tij:;+ .x�, �9 ; within the property lines and do not aneroach onto the property adjacent thereto, that no 0......... ,,, l improvements on the property lying adjacent thereto encroach on the surveyed premises and t.�N1j that there art no roadways, transmission lints a other visible earamants on said prop" k 1 except as Indicated hereon. p p 4;4.4; • ; :�� Ken..._ U. t 1 �l Dated this the [iLDay of LSU6UeL 199 1 , at Anchorage, Alaska 0 rF•lh • 5202.. It is the responsibility of the owner to determine the existence of any easements, covenants, �wa or restrictions which do not appear an tha recorded subdivision plot. a'••'�•t•�•� cg \ I Z "r /4- def TIC d ✓Cn— toof Lot 11 3N �Ie, o v "A', loo Ar A l r Li LvtA'SCMC. ?A'TW,. it lat-cz• MMdmr,97 — '�--Fov+o S/+b"Rrr�.n. N89=53'•50 \/ACA,vt 1'OreALT G PLOT PLAN AS BUILT X SCALE V' 40 I po��o 1�8 RrM.n.. Caster fliNso' Wean Vnae✓r ear GRID 3131 JOB No91•ROD ®lSI1LYS®��ja [:l)L fllCYSg)LOS 1731 George Bell Circle �;,,•., , LYS Ctrs Q o Anchorage, Alaska 99515 ((9O2Y'T%g4T4 V'% ' r I Hereby certify that I Lava surveyed the following described prop arty: p C. "• • • • r Lot I'i .1 ID& 'L A PAK.K F}I I.LS 41f�[�,VIS��A1 ACO. Noy'. J A� .' c � •. }'• 0 ANu1olt.nUte Recording District, Alaska, and Nat the fmpr temente situated thereon are x�:• (� tij:;+ .x�, �9 ; within the property lines and do not aneroach onto the property adjacent thereto, that no 0......... ,,, l improvements on the property lying adjacent thereto encroach on the surveyed premises and t.�N1j that there art no roadways, transmission lints a other visible earamants on said prop" k 1 except as Indicated hereon. p p 4;4.4; • ; :�� Ken..._ U. t 1 �l Dated this the [iLDay of LSU6UeL 199 1 , at Anchorage, Alaska 0 rF•lh • 5202.. It is the responsibility of the owner to determine the existence of any easements, covenants, �wa or restrictions which do not appear an tha recorded subdivision plot. a'••'�•t•�•� r ' MUNICIPALITY OF ANCHORAGE � DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION (,*,DON-SITE ENVIRONMENTAL ENGINEERING DIVISION 825 L Street. Anchorage, Alaska 99501 Telephone 2644720 SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW S 32ISRL ❑UPGRADE MAILING ADDRESS 5 C '— v17-r204 4614q,t9K. 904- LEGAL DESCRIPTION 1 /-07' 13 ALOCK pilglzx wits 5 'S� - LOCATION NO. OF BEDROOMS Uy DISTANCE TO: Well Oi Absorption area Dwelling PERMIT NO. FTAl0 05 d Z2- F-Z Manufacturer Material No, of compartments TELL 3 W N c t rT 57HT/dAl rn Liq.capacity in 00 gallons IFHOMEMADE: rh W�tlth Z Dwelling DISTANCE TO: d 0 CIE < Manufacturer sten i ca achy in gallons O Well Foundation Nearest lot line PERMIT NO. w= DISTANCE TO: C /Z T $O Z Z j 1L z z W No. of lines 3 Length of each line Total length of lines 1/0 FT, Trench width Distance between lines F1 �a.ke. FT. H Topo lila to finish gratla Material beneath the Total effective absorption area o /a /= T (o inches 134SI ge?. r--T' ei Width Depth PERMIT NO. W 1- Type of crib Crib diameter n wn absorption area wd W n Building foundation Nearest lot line DIST Class Depth Driller Distancet�Aine PERMIT N'�O..,4A o /h1 A11,4 W �+ Building foLlinclation DISTANCE TO: Sewer line Septic tank ,v /.y f} Absorption area(s) N14 OTHER PIPE MATERIALS VG "' e ° SOIL TEST RATING 2C SQ, .T1wonm -4- 4- INSTALLER fiCIZFA&F SY.5-reil`145 mp,4, 9 REMARKS 3 / Gov E2 O 3 2 f SYS i EM T 2 $ .. a os� 154 / ^o P ec.L • a. F.a.....; cg s .• ......... �Cr•. �! rc� C' cc•. Corwfn t�0 st •... A 4j�rFES51�"`'s' DATE LEGAL bM r'f PS4J Ldt l3 Ql� Z &Z IN k 013 (Rev. 3//t31/ 1 11 M M ` MUV%J I C I F1AL_ I TY OF APQ C3F:Z!-lGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION. �a 825 L STREET, ANCHORAGE, AK 99501 264-4720 C7N—S I TE SE WF=Fz Fz'F=F2M I T Y V PERMIT NO:' 850722 DATE ISSUED: 11/21/85 AP'P'LICANT: REALESTATE COMPANY ADDRESS: 4155 TUDOR CNTR. SUITE 204 ANCHORAGE, AK 99504 CONTACT PHONE: 345-2122 LEGAL DESCRIP: SUBDIVISION: PARKHILLS #1 LOT: 13 BLOCK: 2 SECTION: 34 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 54000 _(SQ.FT. OR ACRES) rlY Sp TA MAX BEDROOMS: 4 -1 v Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. -- - - - - - - - - - - - - -- ---------------- - - - - -- DEPTH TO PIPE BOTTOM (FT.) �•�t A GRAVEL DEPTH (FT.) Cf 0.5;1 TOTAL DEPTH (FT.) .ypl GRAVEL WIDTH (FT.) lot 1 GRAVEL LENGTH (FT.) 46t GRAVEL VOLUME (CU.YDS.) 6fy TANK SIZE (GALS) 'mss 1� oKs SOIL RATING (SQ.FT./BR) 1-2-$0/b'g_... —T _--- ---I * TANK MUST HAVE AT LEAST TWO COMPARTMENTS - - - - - - _ - - - - - - - - - - - - - - -- - - - - - - - - - - - - - Li�•f Siti..tt•.-t --J1 C'�.•...r.ti /�[o�i'{+•s� •STtFP I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES,' THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE ODTAINED; (2) AS-BUILTS WILL NOT' BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED ---- DATE: - -- ---- ----------------- --------------- APPLICANT: REALESTATE COMPANY ISSUED BY -- -%yf i DATE: ((� -- ----- nn ----II------- ---------- ------ --------------- wi MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG - PERCOLATION TEST j?S SOILS LOG go pert FC PERCOLATION TEST PERFORMED FOR: N Pa h:lr &r DATE PERFORMED: Z/9 /0 7 LEGAL DESCRIPTION:] CLI A 17 i1 " -�- (PT� Pecvh 1 S 711' [01-)0r9An+c (GM)Sanciy GrA.leilySj�� 2 Brown ,Dry 3 0 o ° (s W) i7 rave I l y Cand 4- .° °e o° °A , Glean 125 0, 5— ep cc.rA> Sandy cr vealy s,ll-, o,S ,BILI -Gr' e.d 7 'TNZ 8- s10119- 10- 11 12- 13- 14- 15- 16- 17- 18- 19- 20 21314151617181920 WAS GROUND WATER Yec� ENCOUNTERED? IF YES, AT WHAT DEPTH? f7 11 SITE PLAN PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: ,>f?-/ f'S ✓ CERTIFIED BY: Mow SyO.�Ly2 of 3 72.008 (6/79) DATE: n MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 89501 264-4720 SOILS LOG - PERCOLATION TEST 'SOILS LOG PERCOLATION TEST PERFORMED FOR: Taffe -Y(L OmQo2 DATE PERFORMED: !C�-- LEGAL DESCRIPTION: ?Aa k i -i-' 11 # �� I '� Q k a TIPL Q MR. SLOPE SITE PLAN `O L) z C6m) ISClnda4,CtVaJell`+ 3 a 5 Grp F , mo; st 6 EN O 7 1.1 E 10 Date Gross Time Net Time Depth to Water WAS GROUND WATER S 11 _ Nin ENCOUNTERED? OL 'S�D P 12 8-q `I E IO t447 IF YES, AT WHAT +Neo DEPTH? 13- 'so 14 15 16 17 16 19 Reading Date Gross Time Net Time Depth to Water Net Drop +Hao 9:31 'S�D 03 1 8-q `I IO t447 +Neo 9:" 'so o� • 1 Io +"o Ip O� q.'01 •� +11.20 Q:01 1Q Sp O� •,1 20 II JI PERCOLATION RATE ,'7cL C7 � (^minutes/inch) TEST RUN BETWEEN FT AND FT PERFORMED BY: C fRtP S _CERTIFIED BY: DATE: 72.008 (6/79) oS�l2e+ a 3 N V, SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Or PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Pawl torz,I'07w"). DATE PERFORMED: 7S/ 7 /O 7 LEGAL DESCRIPTION: / hl 11 e , 7 f — F CPf) yeat 1 I (qL) Some SandS/ Sandy,GrovellyS;hP' 2 pry, Gley -Tart 3 4 eea,9(SW)CkanSgf?d .6 -ASS -09 5 ' �� wVGlt rhro•j1t2/wh 6 (Ght) Sandy,GrA�¢.Ily Silt. Qlue. Grey s tH 3 9- 1011 10- 11 12- 13- 14- 15- 16- 17- 18- 19- SLOPE 213141516171819 SLOPE WAS GROUND WATER Y�- ENCOUNTERED? I IF YES, AT WHAT DEPTH? n- / Is 11 1i C 20 -{ I ^ �J lul PERCOLATION RATE 'J OS % (minutes/inch) TEST RUN BETWEEN ...1_ FT AN COMMENTS_;!— Ll aiP rafe. r '/r ALb es PERFORMED BY: � I C. CERTIFIED BY: DA Mor? s><Shen✓ 3� 3 -.MOOS (6/79) ✓1&� " i scl leve Reading Date G,Oss Time Net Time Depth to Water Net Drop tHyo 8 9 Sy o8ao Io as .al O o to ,N3 •o$ + ►IRO of? 30 . SI n + I.4 j20 06,10 O w 1 , 04 a +N2o 08 Sb _ .So -- o40 '1 +H2C 0400 % SO_ O 1 20 -{ I ^ �J lul PERCOLATION RATE 'J OS % (minutes/inch) TEST RUN BETWEEN ...1_ FT AN COMMENTS_;!— Ll aiP rafe. r '/r ALb es PERFORMED BY: � I C. CERTIFIED BY: DA Mor? s><Shen✓ 3� 3 -.MOOS (6/79) ✓1&� " i scl leve w 8 Y •✓✓ FO • Y• r• • •\• Y ✓jam'.♦ •to •p+S=rp✓YQ$r •p Y°Y �O Yr$ y OwJ OY Z •iY .•' $ y• •yJ �� r re �••• M•I o SOOJ^: Yi •' �O:�PY YF •• • Y .$r r :- •r� r�•o > Fp L:S SCJ y ••O�.�YS ry=_• ,t::. ZZ, a. p• 8•• :viyV.••.°.p O-. i OIV�• ..V •. .• F.• ) O • Y��PYY. •.•. •riw✓ ..)F. So ✓°Y•< P• •p Y •. 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O.Y e. yY Y:Y y M e••p i a Y•pAV .r pY ••P •pE O '• yY`Y „°.r MO NA a ]A'r '• 0 00 � r �� rr+.. °'•'•. eE $ g:e EY•i:o by o. •• re YY• �Yae e`e .e Yr p •moi Y q e.p.✓ =_op.� Y � E• i.n E i� ia•• ais •Ce i.•E:i Yp ••O J. .•E 'YYY ` p+•°Yi Oje•�y pY✓)i`Y •�Yi Y• Y <O A-- Y r�o.0.�•••1 .°.Y O•.•i BO. / •• Z r.FiY Ei•p+Fa •E MplplCa ✓ w YOO .$••YOV O Yr/YV: •°r FYpeE •O J: O °Y « • YY•.•iyYY•J YC •• F.00^YJ�MYP<e YY/ <.O.f YS YpPY« Ya00 N p YOY N �r.•• 'El aO• <✓eYY<BOyY . = •(M�Y•FV«<JOY WWW « p <V•rJYME i Fu• Y J lim n i ;E O W cc Q IL W x D. r O [1 S 0 0 0 A 4 y\� (MON, w e�\ § 1,... d � ■\�. & . . E , _. . . , . Municipality of Anchorage 0 e� L -• 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. OI%— 11 — 7 HAA# f/IFO C)62Ly Expiration Date: 1. GENERAL INFORMATION Complete legal description I—o-r 1 ?>i 13 K JAfLtCS \-I: ILLS Location (site address or directions) 1 LI -7 y I tsar k H i I I S C i r -d e_ Current Property owner(s) Day phone 3'f h— 3til 5 Mailing address Lending agency Day phone Mailing address Real Estate Agent ?aitl 1�t0r 4 5Te& �elury�&QDay phone Mailing Address Unless otherwise requested, HAA will he held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site �( Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ 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 4 by an independent professional civil engineer registered in the State of Alaska. Certificates 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 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 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. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm lo Address Engineer's Printed Name S. DSD SIGNATURE %tue_/ ?F Phone X79 -32/1, 9 o2O / ( �A(•YI� aN Date 6 !L/ Approved for _ bedrooms.2a ��`-'• c: ti Disapproved. .Z.7`:,�•� rte, Conditional approval for bedrooms, with`t,•.. he following stipulations: .,.i c)Tr_ Additional Comments WATER AND : °'; Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �—� �a /� �r�� Original Certificate Date:_ - /O —o (RN. 01M) p q.nC� 14 ..s.a.e.s...... F. Approved for _ bedrooms.2a ��`-'• c: ti Disapproved. .Z.7`:,�•� rte, Conditional approval for bedrooms, with`t,•.. he following stipulations: .,.i c)Tr_ Additional Comments WATER AND : °'; Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: �—� �a /� �r�� Original Certificate Date:_ - /O —o (RN. 01M) Municipality of Anchorage .,.. `• Development Services Department Building Safety Division Onsite Water b Wastewater Program 4700 South Bragaw SL P.O. Box 196850 Anchorage, AK 99519-850 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L OT t�AR-� 14 I L -LS 94( Parcel ID: Qt 7 % A. WELL DATA Well type Z, If A. B, or C provide PWSID # Well Log (Y/N) Date completed ?�I93 Sanitary seal (YIN) Wires properly protected (YtN) t_ Total depth Jo 11 fL Cased toi_p-1—ft. Casing height (above ground) n. FROM WELL LOG Date of test I's /o Static water level Lt (10 ft. Well production VU g.p.m. WATER SAMPLE RESULTS: Coliform —9—colonies/100 ml. Arsenic: _ mg.A. B. SEPTICIHOLDING TANK DATA AT INSPECTION 611 oz 7 tt. 7 g.p.m. Nitrate QJ21mg.A. Other bacteria N D colonies/100 ml. Date of sample: S/ o Z Collected by: g Tank Type/Material SKED,e-,_ 5 T E E L Date installed Tank size lboy gal. Number of Compartments Cleanouts (YIN) x Foundation cleanout (YIN) _�L_ Depression over tank (YIN) —ti- High water alarm (YIN) Date of pumping Q t Pumper L saw jig, S C. ABSORPTION FIELD DATA Date installed �-i-86 Soil rating (g.p.d.Atr or fe/bdrm) OW& System type 2 G Length 70 R Width o ft Gravel below pipe O. Total depth 0` ft. Eft. absorption area 1 3 Monitoring tube 4L- Depression over field 1` Date of adequacy test -10 l b Results (Pass/Fail) 7 For E— bedrooms Fluid depth in absorption field before test in. Water added: al. New depth in. Elapsed Time: Y min. Final fluid depth � in. Absorption rate >= & 0-0 g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. UFT STATION Date installed /2 - 45 'Pump on' level at 3(v in. Datum Civ J a E. SEPARATION DISTANCES Size in gallons ITA -0 Manhole/Access (Y/N) "Pump OfF level at 1; 2 -in. High water alarm level at 7i in. Cycles tested 4171- Meets alarm 8 circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfliR station on lot / ° t) f Absorption field on lot j,5 -,q f Public sewer main Nli-%" Sewer /septic service line /00 -/ On adjacent lots > /9-(2 On adjacent lots >/0 .. e� Public sewer manhole/cleanout _ N�4k Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 9L D t Property line I C) -� Absorption field / h Water main K1A Water service line 75 Surface water •a'+ IGtpt i a Wells on adjacent lots IOU + road/ eV,'/c4. - SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10 Building foundation 30 + Water main Water Service line 7_ Surface water 30 iF Dmreway, parkingtveNcIg storage Curtain drain 8 O Wells on adjacent lots ! 1! F. COMMENTS G. ENGINEER'S CERTIFICATION W til& I certify that I 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 T Gb ±K Sp v r k lit H o(/ Date /7 .4" 2. HAA Fee $ 375 4--� Date of Payment '/3/ to 2 Receipt Number ;249t683 (Rev. 12101) , Waiver Fee $ Date of Payment Receipt Number eA— FovwP 2 %7 Ra{ la& a. 0= L•; 232.25 LOT 13 7A Tltr lal.64• Yspe5dmd9T/ Fov..D slef iw tiy�Vy„•s c •'�•'�� GDT_[ car m GIFT sraT ewuc..._ C1.n,-0-n 5 3'• 5o"Y l eSsdT s(DxiotR.�.a TR•AC-)C G _ PLOT PLAN AS 13UILT Y_ SCALE I'4 40' GRID 313'1 JOB• No 3-$ A Vu )Logo O AacLAnch George HellCircle5 orale, Alaska 995515 (9 07 I Hereby certifythat i Lata suneyad the (ellowinq described property: ..J �,,'•••'• •' • rt Lot V5.Blocker PAO_tL l•:1LL$ SJhPNISinll _ FOO. Np. 1_ c�� .r .+ ,Lmcm-Gu Recording District, Alaska, and that the impr vements situated thereon are w t-� '+ .•' within the property lines and do sat ancreath onto the property adjacent therata, that so t•...:..... A .. improvements an the property lying adjacent thereto encroach on the surveyed premises and C, that there are no readways, transmission lines or other visible easements on saidro ± •}>f -•y , P Pity t except as indicated bareon. :•. Kemeen �. l.ny e`i' U, 5202 Dated this tha A±Daj o/ 19')3 , at Anchoraga, Alaska C! •...........!14; municipahly, of Anchorage George P. 11'uerch, Mayor 5.1 ,.. Builditld Sttfcty D1111sion P.O. Box 1W)50 • 4700 S. Bragmc Strcet Anchorage, Alaska 99519.6650 • (907) 313.5301 h ltp://%%i%i'.d.and umage.ak.us 6127/2002 Jeffrey A. Gamess, P.E. Alaska Water & Wastewater Consultants, Inc. 6901 Debarr Rd. Suite 2B Anchorage, Ak 99504 Subject: Waiver Request for Park Hills #1 Block 2 Lot 13 Waiver Request #WR020031 Parcel ID #017-112-57 Dear Mr. Gamess: Your request for a waiver of the required 100 feet horizontal separation from the absorption field to surface water has been approved. The approved separation distance is 70.0 feet. This waiver approval applies to the existing absorption field to surface water separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Daniel J. Roth Civil Engineer On -Site Water & Wastewater Program Municipality of Anchorage . ,.. .. Development Services Department Building Safety Division On -Sitz Water and Wastewater Program � s . . r • - 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 995196650 www.ci.anchorage.ak.us (907)343-7904 Waiver Review Worksheet WR#: WR020031 PID#: 0117-11112-67 HAM Permit#: Date Received: 6126102 Legal Description: Park Hill$ #1 Block 2 Lot 13 Engineer. Jeffrey A. Gamess. P.E. Alaska Water & Wastewater Consultants, Inc. Applicant: Brad Evans Waiver Requested: 70 feet from existing drainfleld to surface water Criteria: Geology Points: A. Water Table B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: )_ Waiver Is not Granted: List Conditions or Reasons for above: : Uv ENG/NEER rJ LAS "AlP of 3"14rr/t1C^77VN Date: 402 6 By: pfFN Name of Reviewer Rec#: 21669 Amount: $1.160.00 Date Paid: 612612002 -'CIN .. . ��- ALASKA WATER & WASTEWATER ------ CONSULTANTS, INC. June 26, 2002 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water R Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Waiver Request - Separation Distance Between Existing Drainfield and Surface Water. Park hills #1 Subdivision, L13, Bk 2 To Whom It May Concern: The MOA recently issued an unconditional NAA for this property. We were retained by the buyers to review the NAA paperwork (prepared by Toben Spurkland, P.E.) so as to insure that their interests were protected. During our evaluation it was noted that the monitoring tube at the north end of the drainfield was 32 feet from an intermittent stream and 74 feet away from continuously running surface water. Water was noted in the intermittent stream during our previous site visits, but the ditch was found to be essentially dry on 6/22/02; therefore, it is assumed that your department would not deem it to be surface water. Both "streams" are the result of curtain drain outfalls. The subsurface edge of the drainfield is approximately 29 feet away from the intermittent stream and 71 feet away from the continuous stream. Attached is a site plan that shows the drainfield, the surface waters, and the general topography. The drainfield is pressurized by a lift station and is located in a heavily vegetated area. The topography is such that surfacing effluent would flow towards the northwest and onto the driveway, or into the south road ditch (location of intermittent stream). The south road ditch would intercept any surfacing effluent and prevent it from running across the road and into the continuously flowing stream. In short, it is not possible for surfacing effluent to reach the continuous surface water located on the north side of Park Hills Circle; therefore, we are requesting that the subject separation distance be waived to 70 feet. The intermittent stream in the south road ditch i$ assumed to be a non -issue with your department. please contact us at 337-6179. Thank you for your assistance. P.IE.. M.S. 6901 Debarr Road, Suite 2B * Anchorage, AK 99504 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: akH,%vc.com LOT BLO 3 I I AR HIL SL CD 1 i PARK LS S/ LOT 7, BLOCK 2 Q PARK LLS S/ \\JJJ jI l\ F'ti 1 / --` 16' SETBACK URF CE-WAIER. \ d. LOT 1f. BLOCK 2' PARK HILLS S/D /1/ 1 RIDGE S/D ExISTINO DRAWN BY: 1 AIASKA «TATER & NVASTI:�VAI R s- =/"'- _._.. — �.._._._. CONSULTANTS. INC. -- ---- CT, 0 10 A+ A11C-."ACF. wONFl ooruv.Ano • FA (917M%A-374e 1 �REPAREDIFOR I ! 1 —PHONE NUMBER: PA E NUMBER: BRAD'EVANS ``. I 344-5222_ 1 OF 1 _EWL DESCRrPTIOK PARK HILL jfl,,`LQT 13, BLOCK 2 / TYPE OF WORK: II \ V SITE`PF�R N(AIVER FROM SUR4kCE WATER TO F QLD r 1:r. LSLS/O /1 11 a----- ---------- .............. . ..... MIT i \ C, ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901 Debarr Road, Suite 2B -Anchorage, Alaska 99504 907.337-6179 - Fax 907.338-3246 -w .okw c.corn I1' -=:301 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services it On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1. GENERAL INFORMATION Complete legal description L_ I3 8Z PQyk VN "M S P -I Location (site address or directions) 14-74, 04\% C -rde, Property owner 11n,100V 11yQ_ 140^"i Day phone 0996SA- Mailing address -7`h-g �• 99SI$ Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest - Ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: N� Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. J2�'15 (R•v.1N1) Fro l MOA121 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Address RM Engineer's signature 6. DHHS SIGNATURE Approved for 3 bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By.. J O wa �� m (n -f- Date Z VITIC The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an Independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. mass Mw.1A+) e.a MOAR21 • Municipality of Anchorage AL Department of Health and Human Services dam HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: (..13 132 PNwyiAit15 fI Parcel I.D. A. Well Data Well type PRI V A r- If A, B, or C, attach ADEC letter. ADEC water system number Log present (YM) ON FILO Date completed 3-7-18-93 Driller AL PIaE-DR1Lt)N(r Total depth 10 " Cased to I Ole Casing height Z Sanitary seat (Y/N) %/ Wires properly protected (Y/N) FROM WELL LOG Date of. test 3-Z9-93 Static water level 44' St told 6eyaND Well flow 4" 9•P•m• Pump levell 9-7 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot Absorption field on lot tlo0' AT INSPECTION 3 c oz cr2 rr't -' rn > r g.p.m.t o rrt v, A •� < z rrl w 0 o On adjacent lots +1 Oo 6 ; On adjacent lots +100' Public sewer maim Public sewer manhole/cleanout-{"1O°' Sewer service line +A.Z)' Petroleum tank -Hao' WATER SAMPLE RESULTS: Coliform 0 Nitrate < M A L- Other bacteria 0 9-L5-93 Collected b ,'v¢ l 1;-e Date of sample: Y� T B.SEPTIC/HOLDINGTANK DATA (tlrr sra) Date Installed I z -S- E35 Tank size Compartments Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y_Depression (Y/N) fJ High water alarm (Y/N) #J":) Alarm tested (Y/N) Date of pumping "I -Lk) _Pumper — SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot +100' On adjacent lots 4-loy Foundation 15' To property line 4"-2:571 Absorption field 1 Water main/service line rSO* Surface water/drainage .0-100, 72-026 (3M3)• Fwm CONTINUED ON BACK PAGE C. LIFT STATION Date installed IZ-S-,%S Manufacturer ArNc_ ow-t+GC TFANk Size in gallons 1 SCko Manhole/Access (Y/N) Y Vent (YIN) �l "Pump on" level at +7-.{ .Pump off" Level at High water alarm level Y Cycles tested Meets MOA electrical codes (Y/N) Y SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot 'I ( Qo D. ABSORPTION FIELD DATA 7- On adjacent lots "1'1 eo Surface water 460 Date Installed 17- -IB5 Soil rating (GPD/Ft2) System type BED Length -7G{ Width Is, Gravel thickness 'anon v{ve Totaidepth 'I Total absorption area 1,565 Cleanout present (Y/N) Y Depression over field (YM) PJ S"Trrv\ 14NS Nver < Date of adequacy test newO Jswy ?Kine Results (pass/fail) — for — Bedrooms 't0 T$>Tl n�fr Water level in absorption field before test After test Peroxide treatment (past 12 months) (Y/N) '- If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot +too On adjacent lots ttc� Property line To building foundation 41s", To existing or abandoned system on lot On adjacent lots I- 3e Cutbank ++5o Water main/service Surface water -r"tao' Driveway, paridng/vehicle storage area Curtain drain *ZD { E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in izSignature✓','TPLF� Engineer's Name 19Z Nw.rl� j �• � ka n Date 9 1-93 y d� �c7Sti h�. ss. HAA Fee $ Date of Payment Receipt Number 5 �gy 72-026 (397)• Back Waiver Fee $ Date of Payment Receipt Number, inspection. R