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Home My WebLink AboutPARK PLACE #1 BLK 2 LT 4Park Place #1 Lot 4 Block 2 #020�092�62 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: OSP241053 Work Type: SepticTank Renewal Tax Code Number: 02009262000 Site Legal Address: PARK PLACE#1 BLK 2 LT 4 G:3337 Site Mailing Address: 16731 STONE RIDGE RD, Anchorage Owner: HARTNESS JOY TRUST Design Engineer: FORGE ENGINEERING This permit is for the construction of: Effective Date: Expiration Date Lot Size in Sq Ft: Total Bedrooms: �»cnt Department 4/23/2024 4/23/2025 79051 ❑ Disposal Field Q 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: E-O %� Date: Issued By: �---- Date: Z 3 Y OF HCHO ,AGE 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. 020-092-62 Property owner(s) Joy Hartness Trust / W.R. & G.C. Johnston Day phone Mailing address 16731 Stone Ridge Road Site address Same Legal description (Sub'd., Block & Lot) Park Place #1, Block 2 Lot 4 Legal description (Township, Range & Section) Lot Size 79,051 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X Septic Tank ❑X Upgrade ❑X (w/wo ADU) Holding Tank ElRenewal ElDuplex (D) El Privy ❑ Multiple Dwellings ❑ (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: $/ y 5, Waiver Fees: Date of Payment: `% ('2-0Z ly Date of Payment: Receipt Number: Permit No. 05R-,/053 Receipt Number: Waiver No. Permit App_'- : ._.,:c April 16, 2024 MOA Development Services, On-Site Water & Wastewater Program 4700 Elmore Rd Anchorage, AK 99507 Subject: Park Place #1, Block 2 Lot 4 – 16731 Stone Ridge Road Septic tank replacement permit Dear On-Site Services Engineer: The septic tank on the subject lot has failed and must be replaced. We are submitting this permit application for the installation of a new 1,250-gallon S.T.E.P. Tank. The existing tank and lift station will be decommissioned in accordance with Municipal Code. The existing absorption bed will remain in service. The attached site plan identifies the location of the home as well as the existing well, and the existing septic tank, lift station and absorption bed. No conflicts exist between this proposed system and any other well or septic system, whether on this lot or adjacent lots. Stormwater drainage will not impact this septic system. The new tank will be placed outside the limits of the existing deck. It will be a minimum of 100’ from all wells and surface water, and more than 5’ away from the existing absorption bed. Please refer to the attached plan sheet for the design. If this design is followed, 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 OSP241053, Curtis Townsend, 04/23/24 LOT 5 EXISTING ABSORPTION BED Benjamin Schiller CE 12592REGISTEREDPROFESSION A L E N GINEER 1"=50' NEW 1,250 GALLON S.T.E.P. TANK MIN 10' FROM FOUNDATION AND 5' FROM DECK SUPPORTS DECOMMISION EXISTING TANK CUT OPEN AND FILL WITH ROCK OR CONCRETE PER CODE CO - CLEANOUT 2CO - DOUBLE CLEANOUT FCO - FOUNDATION CLEANOUT FS - FLOW SPLITTER VALVE MH - MANHOLE MT - MONITORING TUBE SV - SEPTIC VENT TH - TEST HOLE LEGEND FEET 0 50 100 SEPTIC PLAN 4/16/24 EXISTING WELL S T O N E R I DG E R O A D 10 ' T & E E A S E M E N T CENTERLINE 25' CREEK MAINT. EASEMENT CA R PO R T 3-BDRM HOME DECOMMISION OR REMOVE EXISTING LIFT STATION CONNECT TO EXISTING 2" MANIFOLD PIPE PARK PLACE #1 B2 L4 - 16731 STONE RIDGE ROAD Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241053, Curtis Townsend, 04/23/24 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: OSP181057 Effective Date Work Type: SepticTank Upgrade Tax Code Number: 02009262000 Site Legal Address: PARK PLACE #1 BLK 2 LT 4 G:3337 Site Mailing Address: 16731 STONE RIDGE RD, Anchorage Owner: JOHNSTON GRACE CAROLINE & Design Engineer: FORGE ENGINEERING This permit is for the construction of: Expiration Date: Lot Size in Sq Ft Total Bedrooms: �p\Cll( r Department 4/26/2018 4/26/2019 79051 ❑ Disposal Field R1 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: AW&�u Date: Lf b i Issued By: Date: 3 MUNICIPALITY OF AN - • ' AGE sy 7o17 Community Development Department �1 f { • e: 907-343-7904 Development Services Division a t\,PR �� ; 2013 • :x: 907-343-7997 On-Site Water & Wastewater Program ti ON-SITE SEWER/WELL PER z• 'PLICA 10, / a6g1. °' Parcel I.D. 020-092-62 Property owner(s) Caroline Johnston & William Ross Day phone 891-6310 Mailing address 16731 Stone Ridge Road Anchorage, AK 99516 Site address Same Legal description (Sub'd., Block & Lot) Park Place #1, Block 2, Lot 4 Legal description (Township, Range & Section) Lot Size 79,051 Sq. Ft. Number of Bedrooms Three (3) APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial Ti Single Family (SF) A (w/wo ADU) Septic Tank X Upgrade ❑X Duplex (D) (� Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy LJ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I 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: 06- - Waiver Fees: Date of Payment: /a4`/9 Date of Payment: Receipt Number: O6/6 0 0 Receipt Number: Permit No. o5P17/05 ? Waiver No. Permit App_ :._c ��Ilr ) ' GE E N O I N[R R I N G PO BOX 240773 ANCHORAGE,AK 99524 522-7773 677-7766(FAX) April 23,2018 Municipality of Anchorage Development Services Dept-On-Site Water& Wastewater Program 4700 Elmore Rd Anchorage,AK 99507 Subject: Park Place #1, Block 2 Lot 4 —Stone Ridge Road Septic system design and permit application Dear On-Site Services Engineer: The septic tank on the subject lot has failed and must be replaced. We are submitting this permit application for the construction of a new 1,250 gallon S.T.E.P. Tank. The existing tank and lift station will be decommissioned in accordance with Municipal Code. The existing absorption bed will remain in service. The attached site plan identifies the location of the home as well as the existing well, and the existing septic tank, lift station and absorption bed. No conflicts exist between this proposed system and any other well or septic system,whether on this lot or adjacent lots. The new tank will be placed outside the limits of the existing deck. Stormwater drainage will not impact this septic system. The new S.T.E.P. tank will be constructed in accordance with Municipal Code. It will be a minimum of 100' from all wells and surface water, and more than 5' away from the existing absorption bed. Please refer to the attached plan sheet for the septic design. If this design is followed, there will be no adverse impacts to adjacent properties. Sincerely, Michael E. Anderson, P.E. ••�: •s'r�� i* 49TH , •*p Attachments 0,•• ie vol.MICHAEL E. ANDERSON •:• � # al 1r,.•• CE-4381 :\_`�- #�e •�3 �Fo`;'.23 •/ ►�• . �,1,''WO FEW" +tel'' PARK PLACE #1 B2 L4 - 16731 STONE RIDGE ROAD S' .......„. ...... ....,„ ..../... / CENTERLINE 25'CREEK / MAINT.EASEMENT � / I - --' � 'T / / LOT 4 / Q / _ - - _ O '� �' CI.IAIAcLINK FENCE W / ter... it 0 / 0 1 / o� IIIw yu !STING LL /0 w w / I- I . . . LOT 6 1 ® • = I 1 C11111111 \ REPLACE EXISTING SEPTIC / \ TANK AND LIFT STATION WITH 3-BDIRM HOME \ NEW 1,250 GALLON S.T.E.P. / EXISTING 500 GALLON \ TANK, DECOMMISION EXISTING S.T.E.P.TANK \ TANK AND LIFT STATION IN / \ ACCORDANCE WITH MUNICIPAL / CONNECT TO EXISTING 2" \N CODE. `\N // !‘ = . MANIFOLD PIPE. N N � r• �\ \ , NOTE: NEW 1,250 GALLON' I NEW 1,250 GALLON S.T.E.P.TANK MUST BE S.T.E.P.TANK I LOCATED>5'FROM DECK AND>10'FROM I -- HOUSE FOUNDATION. EXISTING ABSOR• N TLOT 5 BED. IK oA`e OF A/44. LOT 3 ,S .,• !::.....;9 . I ,`P•• A �S NOTE: 004. :• TH o' .;),___.to NOTE: NO SLOPES>25%WITHIN 50'OR SURFACE WATER WITHIN 100'OF THE LEGEND ® 49- ' ` :�'�J PROPOSED SEPTIC SYSTEM CO CLEANOUT 0 � ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS 2C0-DOUBLE CLEANOUT M' FCO-FOUNDATION CLEANOUT i,c'•MICHAEL E. ANDERSON : PROPERTY ARE SHOWN.NO CONFLICTS WITH WELLS OR SEPTIC •. CE-4381 ••' ' SYSTEMS. FS FLOW SPLITTER VALVE #OP<`�'•y-24- f ••.•, 44> 0 50 100 MH-MANHOLE fit, 0�°ROF• S _,A.�� FEETIIIII SLOPES>25% MT MONITORING TUBE klr vooP1� SLOPES>46% SV-SEPTIC VENT 1"=50 TH-TEST HOLE Mayor Development Services Department Building Safety Division On -Site Water a Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99507 w�.muni.orq/onsite (907) 343-7904 Pump Installation Log Well Drilling Permit Number: SW Njimhe.r! Date of Issue: — Property OwneL.�qame & Address: Legal Description 949 -94 K /4 C 77 )(pJ31 - �z 1--)4 &K Pump Installation Date: 01 1 st na� pump Intake Depth Below Top of Well Casing:/ 7ej feet Pump Manufacturer's Name: A( 111c.Dg,�JA)A-LP .agj"o ��43LTS pump Model: pump Size 11/to Pitless Adapter Burial Depth:/(> feet Pitless Adapter Manufacturer's Name: Pitless Adapter installer: A) Well Disinfected Upon Completion? &es F_� No Method of Disinfection: 6L.7 Comments: 0 Pump Installer Name: Aiqc�40_Y_Zky (Aj_lt�v / A�� Attention: The pump installer shall provide a pump installatilon log to the DSD within 30 days of PUMP installation. 0Z6_0q'z MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "V Street, Anchorage. Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT hla,ne, DISTANCES SUSApq LA6RA-4bc L- JIM HARPER SEPTIC ABSORPTION WELL �rihw, FROM�T' TANK FIELD /6730 S-rol,46 Rtb6e RD phonate) pwrn.1 t�. 0 looms WELL 1214 144 2-72 9c) 0239 3 LOT LINE 15 -72 LEGAL DIESCR.PTION Lot :2 1'"WRk Pl-,JC,5 FOUNDATION Vo so I Townt,hlp. S,(;hoh AS -BUILT DIAGRAM (Show location of well. septic SYStem. ProPerlY IlhQ1. f0uw&h0h- dn ay. water boo". CC.) I TANKS --h RTIRI/I � I A I C V jj- SEPTIC el- & i rr s'rw 0 HOLDING fLi #=r ST PeCity M 9111"ll If, L CII'A IC S ? � ;6wt;ompan�ls k sl z — 4_ malff.w - ".4pl, J%ll a TYPE OF SYSTEM —3 w 0 TRENCH 13ED 0 W. DRAIN 0 OTHER Depth to Pipe WIGM IFOM lotal Cepth Ilt,,h Ohg-" 911109 ,hgmai g,aote 1.6 — 14.2S FT 2 - q 7T F7 . 43" fill W� a� 9'a0i, Gravel Mpth ben"m pope O.S 2- — -S FT FT if 4.E 21 G,th,&i �glh ,is G,,erel �Wlh 2o 30 FT - IT �s Aft AT.C. I'l I 0 A. low al ar" D.Slahoe pehe&&n knelt, I :zs SO FT st FT �51 Numbet, of hhes 9 S�l lal..g 3 7S' FT I&IIAT"ft SO D 40 PVC- Insulter L1 '10 —L -)t U CAIZL'S EXCAVATIFIC. Vale Instatle,cl It)117/90 WELLS F.YIST IN 6 0 PRIVATE 0 OTHER (IdentlIvI Ci�l Aum (AB.C) Tcolai Depth F77 FT imialie. Date I.Stall". REMARKS: j2,r,&, oetu,,= �eo- jlves A to< IQ 7S" 0 ;-k pf-tv, ! cdc ww AL, . S*vh�, 1W4 k LA � /c, 7_-_—X 19- 57 ro .f "^ * 714. keTrecl-r;c IF JAiAuffedien t, 1, r-c�GAq., 02�e 44 Inspections FIATToP Performed TEcil- by: !;vcS Ab- lff� ';�� A� aA9t Ctf,0rV�04! 4y VA 12./7/qt� A(c,Lro -J�I&Lf to P"=2 Zb Dahl CEq1—fD0l13 4 9 t (4 �jfe .... .................... 60;11CO�00,02 F.0 '.'.COPE terfify ft IN& Wpection Was pedorMed KoDrding to all 111unidpil and Stme p1defires In efled sn this dalt Health Deepartment Approval. 72-013 (3185) t 0 Ul Cc; Ck: LU a (L Cd oc ul -j w 0 uj co w CN 60 qr g "t LU 4 -4 IL 14. LU V) Ul 7 .Nc C4 w U- 0 CD ku IS -+ Zu 'Ao r ..... CN 60 qr g "t 4 -4 IL 14. to V) 'Ao r ..... Ll 1 -3 Ll 'j INSPECTION REPORT MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 3500 EAST TUDOR ROAD V RAI *AaA INFORMATION (907) 786-8211 NAM 454 f2o P'XIT N 'qzrn le d STREET ADDRESS 114) 136 1 effl-�ef PHONE21-a�9 I/ LOT / -�ZBLOCK K�- SLISDIV. DATIIZ� FOOTING 0 ELEC. TEMP. eAG.UNDGFL— FOUNDATION — 0 EL t��FLBG. ROUGH — BOND 13EAM 0 ELEC. ROUGH 0 GAS TEMP. FRAMING — 0 ELEC. FINAL 0 GAS INSULATION 0 OTHER MECHANICAL — SHEETROCK Cl MECH. FINAL — STRUCT. FINAL 0 FIRE FINAL 0 PLBG. FINAL — OTHER — 0 ZONING 0 OTHER — 0 0 0 0 El 0 0 0' TNO NONCOMPLIANCE OBSERVED 0 CORRECTIONS ESSENTIAL AS - EXPLAINED BELOW 13 WILL REEXAMME AT NEXT INSPECTION r3 DO NOT CONCEAL UNTIL REINSPECTED INSPECTOR DATE 41HEN CORRECTIONS ARE MADE. PLEASE CALL FOR INSPECTION DO NOT REMOVE THiS NOTICE 64-M jAw. 11/87) e M U N I C I P A L I I Y 0 F A N C H U k A b L Department of Health & Human Services 025 L Street, Anchorage, Alaska 99501 343-4720 0 N - S I T E S E W E R Permit Number: 900335 Upgrade Date Issued: 10/11/70 Engineer Designed owner Name: SUSAN LAGRANDE & JIM HARPER oonor Address; 16730 STONE RIDDE ROAD ANCHORAGE, AK 99516 R E R M I T � Loq OD 3 '56 rarcel Id: 020-092-62 Lot Legal: Subdivision: PARK PLACE 01 Lot: 4 Block: 2 Section: 3 Township: IIN Range: 3W Lot Size 79051 (sq.ft. or acres) Day Phone: 272-4741 Mom bedrooms: This Permit: 3 lotal Capacity: 3 SEPITC TANK: Minimum total suptic tank capacity: 1,000 gallons. Each septic tank must hove at least 2 compartments. Depth to top of septic tank(s) < 4.0 frpt requires insulation over tank(s). PEkNII EXPIRES DECCMDOR 31, 1990. PEPMIT ISSUED USING AMC 15.65 PASSED 5-20-06. [_Ni�[NLER '10 RE -VERIFY DEPIH TO GROUNDWATER PRIOR TO BEGINNING EXCAVATION. EtI13JHLER MUSI VERIFY INTEGRITY OF EXISTING S.T. I CERTIFY THAI: 1. 1 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. 1 will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 5. 1 will adhere to all MOA and State of Alaska requirements for the set bact, distances from any existing well, wastewater disposal system or public sewerage system an this or any adjacent or nearby lot. 4. 1 understand that this permit is valid for a maximum of I bedrooms. I also undorstand that the capacity of the total system i5 3 bedrooms and any enlargement will requim an additional permi . Siqnvd: ?ho._� --- VIA?& --- ----------- QAOwner) SUSAN LAGRANDE & JIM HARPER Issued Dy: OWN DATE: DATE* Municipality of Anchorage Department of Health and Human Services Tom Fink, 825 "L" Street Mayor P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 October 11, 1990 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 4 Block 2 Park Place #1 Waiver Request #WR900039, PID #020-092-6V, Permit SW900335 DI Dear Mr. Moore: Your request for waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 5 feet to common property line with Lot 3 Block 2 Park Place #1. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will require all separations be met or another approval from this department. Sincerely, Susan Oswalt on-site Services SO/ljm Concur: §�)hWnSIILII: rogram Manager on-site Services (K'- WELL DR%vc W'4y LO 7' 'Y 13 1- 11 2 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION COT I i 1990 RECEIVED LOT 3 I SEPTic S`TANbPJF1F Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 -ro 4 c% T—H i'�k .......................... !�r; eqP4 ... ... ... ....... . Ti[EOO,),,Z F. MOCRE : , CE - 35-3? Ar A EXISTING 3 BORM VIOL)SE TEST, A OLE f LOT E 30 RANSOM RIDGE 0<-- SEPTIC STANDPiPE 0 T- 'Yf B 1,0 C 1—, 2., P14 R K P I- A C E .5 E PT -1 C srcrE(-i (,(p6:r?Aoe � irff Pi -A" SCALi=- : I"= 3'0' OAT-j5z: B190 DL -N 9�': TFI'7 Norr--.* T"I.1 1.1 NOT A S"Rvig-rea pt -,47 - At -t- I-OCAW�,Aff t4Evv 4500 6AL TANK watl rewde X EXISTING LIFT e.TAT,0,4 ISe' 4BANbamrb Ex""`IG 6OU. ABS 8Fb '10 IRE ABAmDot460 ul FROros,Et� -SOIL Atc Ub ra EXISTING 1000 GAL sEertc TANI: f LOT E 30 RANSOM RIDGE 0<-- SEPTIC STANDPiPE 0 T- 'Yf B 1,0 C 1—, 2., P14 R K P I- A C E .5 E PT -1 C srcrE(-i (,(p6:r?Aoe � irff Pi -A" SCALi=- : I"= 3'0' OAT-j5z: B190 DL -N 9�': TFI'7 Norr--.* T"I.1 1.1 NOT A S"Rvig-rea pt -,47 - At -t- I-OCAW�,Aff t4Evv 4500 6AL TANK watl ORENCO LIFT STATIOIJ EXISTING LIFT e.TAT,0,4 ISe' 4BANbamrb Ex""`IG 6OU. ABS 8Fb '10 IRE ABAmDot460 FROros,Et� -SOIL Atc Ub f LOT E 30 RANSOM RIDGE 0<-- SEPTIC STANDPiPE 0 T- 'Yf B 1,0 C 1—, 2., P14 R K P I- A C E .5 E PT -1 C srcrE(-i (,(p6:r?Aoe � irff Pi -A" SCALi=- : I"= 3'0' OAT-j5z: B190 DL -N 9�': TFI'7 Norr--.* T"I.1 1.1 NOT A S"Rvig-rea pt -,47 - At -t- I-OCAW�,Aff 45 1 FROM LIF-�� 1 S'rA*rlD?4 0 " T. 30 "A Ll 0 "A 0 %4 4r L L MUNICIPAL17Y OF ANCHOpAC;E DEPT. 0 OF HEALTH & ENVIRONMENTAL PROTECTION COT 4 Q-1 1990 Note: Pro�icx& 0--" PLAN VIEW linfel-wo"t coct i6rr�ier S I tuide beI44�"n Ne evtqf of tA e b,&-( &L fic. �0'0 v of 04r betnir Zlskfi 1/ts me4te bar�ter '6'preveii -horizonlar Row 2 1 EXCAV4'rION 2' T N,h: Provicle 17ediLm r .ana -A-11 at lieceatr 4v exchievP Ct te'ef b,je _4r Me br-11 VtACLASSIFIEt> FILL m. -r - RECEIVED NArive si4rr 6:RAL004 T N 4 SEWER 6RAVEL I I -raTAL BELOW DIST. PIPE SEWER GRAVEL SECTION �A—A to FlattOP Technical Services 14530 Echo Street Anchorage, Alaska 995ir -0*0' -WIMIA'A.4 It OF A to , v C..) 491-H 1H,0D0.-,Z F. IACIOR� CE -3589 -' �� 'v AF ....... , 'vl� Ar OP16INAL ISRADE INSULATIO" (2.. � FIL-rER FABRIC No7V: 7-44 naxlmu'n apA of nal <Xcerx- bel�w oe na" I ffrou'd level LOT 41 BLKI PARY PLAC5 ABSORPTION BED PLAN MALI SECTIOVA SCALE-. I" = to I DATE: : q A 0.0 Dwtq SY4 % Rev(se--t to/go Flattop Technical Services 14530 Echo Street Anchorage, AlasIca 9951P Lot 4. Block 2. Park Place S/D 167.iO Stone Ridge Road Septic System Upgrade Specifications and Design Notes MUNICIPAM DEPT. OF ENVIIONMENTAL 'OCT RECEIVLD r�. 1. The scope of the project consists of abandonment of an existing lift station and soil absorption drainfield. and installation of a new package lift station and construction of a ne,w soil absorption drainfield. All construction practices and material specifications shall be in accordancewith Municipal and State requirements. 2.. The project shall be constructed as shown on the site plan and design drawings, except that minor modifications may be allowed or required by the engineer conducting the inspections. 3. The proposed configuration calls for the edge of the soil absorption bed to be as close as 5 feet from the top of a natural hillside which drops off to the west at slopes ranging from 25% to 60%. This configuration is necessary due to the extremely limited area on the lot which is suitable for construction of a soil absorption system. The entire remaining portion of the lot. located north of the residence is poorly drained. and subject to a shallow seasonal groundwater table. A waiver of the normally required 50 foot setback from slopes in excess of 25% can be justified by the fact that the measured perc rate in the surficial soils adjacent to the slope is .5 minutes per inch, indicating that effluent will be able to readily migrate downwards through the soil. rather than having a tendency to migrate horizontally and eventually daylight through the side of the slope. 4. A waiver is also being requested to allow construction within 5 feet of the property line common with Lot 3. This waiver is necessary in order to maximize the use of the limited suitable area available on the lot. Granting this waiver will not affect the potential for future development on Lot 3, because the configuration of the driveway precludes septic system construction on the adjoining portion or Lot 3. 5, The soil absorption bed has been sized on the basis of 375 square feet per bedroom which corresponds to a perc rate of 30 minutes per inch, despite the fact that the perc rate measured at the test hole is 5 minutes per inch. This oversizing is believed to be prudent based on several soil tests done nearby by others. indicating significantly slower perc rates, and also based on the the observation that the existing soil absorption system appears to be significantly undersized. The purpose of using an average perc rate of 30 minutes per inch is to compensate for local variations in soil conditions. 6. The existing septic tank is to be retained provided a new cleanout is installed giving access to the second compartment, but the existing lift station is to be abandoned by removal of the mechanical equipment inside the housing, and then crushing and backfilling, or otherwise properly disposing of the lift station. A new package lift station Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 (Orenco or equal) is to be installed in a 500 gallon steel tank at the location shown on the site plan. The lift station tank shall be equippedwith a watertight manhole riser extending at least 6 inches above ground level. 7. The new soil absorption field shall be configured as shown on the plans. The native soil base of the field shall be achieved by stripping any fill overburden plus the Peat and sandy loam strata to expose the top of a gray silty gravel stratum. Due to a 7% slope in the gea, in or4er to achieve a level base. the depth of the excavation will vary from ------ h end W.0 feet at the north end. The use feet at the sout of sand or retention of undisturbed native sandy loam in portions of the field may be necessary a achieve a level base. In the area where the new soil absorption bed overlies the old one, the sewer gravel and adjacent contaminated soil is to be removed and placed as fill along the west edge of the new soil absorption bed. The area from which this material has been removed shall then be filled with medium sand to achieve a level surface at the same elevation as the remainder of the bed. The portion of the old soil absorption bed which is not affected by construction of the new field shall be abandoned in place. 8. After the base of the soil absorption bed is prepared, a total of 12 inches of approved sewer gravel shall be installed. The pressurized distribution piping shall be installed level with the bottom of the pipes being 8 inches above the bottom of the sewer gravel. The line leading from the lift station to the soil absorption bed, and the manifold along the east side shall be 2" dia. schedule 40 PVC. The distribution laterals shall be 1.25" dia. schedule 40 PVC with 1/8" dia holes drilled in the bottom side on a 240 spacing. The holes are sized and spaced to achieve even distribution with a 4 - 5 foot residual head given a 34 9PM output of the lift station pump. The ends of all laterals are to be capped, and all joints in the pressure distribution network are to be glued. 9. The top of the sewer gravel shall be covered with approved filter fabric. and insulated with 2" thick, approved. burial type insulation. The insulation shall then be covered with unclassified soil to a minimum depth of 2 feet. The surface of the cover shall be contoured and sloped to direct surface flow away from the soil absorption bed. Fill slopes shall be 3:1. 10. The owners shall arrange permission for access to the construction site from the owner of the lot to the south. The contractor shall be responsible to obtain new utility locates as needed. 11. A total of 5 engineering inspections will be required during construction: (1) Initial stakeout of the bed (2) after the base of the bed is eicavated, but before any fill material is placed. (3) after the base surface of the soil absorption bed is prepared, (4) after the sewer gravel is in place and the lift station is installed, with all the piping connected up. but prior to placement of the filter fabric or insulation. and (5) after the final backfill is complete. Y'lattop Technical Services 14530 Echo Street A VAkWI prty J )GA- 9f a g99 516 DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: SUSAN LrGRAND .. . . . . . . . . 011"" _ _ '�iAQ ............... 0 .... ... 00 f; .... .. x SACORC -* CE - 3587 RATE PERFORMED: 9/20/90 LEGAL DESCRIPTION: LL40 R2- PARK FILAC-E To ship, Range, Section: See-& 7-11N, IFEET) (SM- FILL PT '� ASH 2 - SM SAgDY LOAM 3- WITH COBBLES 4 4POCICETS OF 6w 5] 6M/ML 6 SANDI SIL�V ISRAVEL , I DRY 4 LOOSE NEAR TOP INCREASIN6LI MOIST- 4- 8 COMPACTM W- DEPTH 9 10 12 13 14- UNIOPALITY OF ANCHORArE DEPT. OF HEALTH & 15- E qVIRONMENTAL PROTECrION 16- OCT I i 1990 17 - RECEIVED 18 � 19 20 WASGROUNDWATER ENCOUNTERED? - NO H&O cL f 6'--9 " Below IFYES,ATWHAT ft�&' DEPTH? 16,146A90 Cepth to Wila After Maniluing? - DRY calt-8 �:Zc Reading Date G!oss Time Not Time 61114) Depth to Water Not , , DropQti) 812.0 14:,tT 27 P�, ENO + S-.Og ENSWINEAZINNE1 00111110100111FAINNI mmmummmamll Iwo i y,O S:21:00 OMEN 23 3t OMEN 5:261.00 -5, OMEN 1 y1t + mulm Mai MEN ME Emilio NONE NNINE NONE 0 ilm momillmovAlfflual NEW ONEWONJENEll mommulummon NEON WININ #2 LIU 30 ONFAM011111 V.19R. hill 22 7/,(. + N,Q Q32 14) 0 23 Y -L WASGROUNDWATER ENCOUNTERED? - NO H&O cL f 6'--9 " Below IFYES,ATWHAT ft�&' DEPTH? 16,146A90 Cepth to Wila After Maniluing? - DRY calt-8 �:Zc Reading Date G!oss Time Not Time 61114) Depth to Water Not , , DropQti) 812.0 14:,tT 27 P�, + S-.Og — let - 2G i y,O S:21:00 - 23 3t ,%I -- 5:261.00 -5, 22 Y4 1 y1t + S*..,2 1. 4 so 23 V, #2 LIU 30 — �5' 22 7/,(. + N,Q Q32 14) 0 23 Y -L it 3 T%37:00 22 .37'-30 23 Pt 5'.q2*. 30 9, 2-2 -7/1(. PERCOLATION RATE S, (minutesionCh) PERC HOLE DIAMETER -7 TESTRUNBETWEEN L4.7f FTAND 5--25' FT COMMENTS , M.T. I NS-rALLED PERFORMED BY: f�(ett&e Te:cA C v ej CERI IFY 1HA1 THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) F 1 J'ATTOP TECHNICAL SERV JCE&� CIVEL&EN*',IRON'%fENTALENCr�EERViG - ENERGYCO.N'SERVAInO.N&A.NALYSLS THEODORE F. MOORE, P.E. September 21. 1990 14530 ECHO ST. Pit: (907) 345-1355 ANCHORAGE, ALASKA 99516 M.O.A. Dep't. of Health and Human Services P.O. Box 19-6650 Anchorage, AK 99519 Attn: Susan Oswalt and/or John Smith RE: Septic upgrade permit for Lot 4. Block 2, Park Place S/D., Addn. #I Dear Sirs: The purpose of this letter is to respond to the concerns raised in the DHHS review sheet dated September 17. regarding the proposed septic system upgrade for the subject lot. Our responses follow in the same order as your comments. / (1) We had intended to place the unsuitable material excavated from the old soil absorption bed as fill along the west side of the new soil absorption bed so as to increase the effective horizontal separation distance from the steep slope. This material would be covered with at least 12 inches of clean soil. and thus we did not feel it warranted additional treatment. Another approach which we could adopt if you request, would be to place this material as the lower portion of the unclassified soil cover material directly on top of the new soil absorption bed, or alternatively this material could be buried in a pit outside the perimeter of the new bed. and the material excavated from the pit used as the cover material instead. / (2) We will check the integrity of the existing septic tank in conjunction with the specified installation of a cleanout providing access to the second compartment. (3) We looked for. but could not find, any indication of TH #411 or it's monitor tube, hich was reportedly put in in 1982. On September 26 the monitor tube for our test hole did show water at 10'-4" below ground level, which is approximately 5 feet below the deepest end of our proposed soil absorption bed. 'I suspect this measurement does not represent a true groundwater level, however. but is instead a result of the collector effect ,of a relatively large open test hole subjected to a large amount of rainfall in the past few weeks. In June, shortly after breakup.we did have an opportunity to check a deeper monitor tube on lot 5 of Ransom Ridge S/D located to the east of our proposed system and itwas dry at that time. The owners of the subject lot need to upgrade their failing system this fall, prior to the advent of snowfall, so monitoring groundwater through mid- October would create a real obstacle to constructing this upgrade. t4) We are requesting a waiver of the provision in 15.65.040.1.2 requiring a 50 foot setback from a slope exceeding 25% for the following reasons which we believe justify your exercising the review latitude provided for in 15.65.040.C. As described in the previously submitted design notes. we measured a percolation rate of 5 minutes per inch in the subsurface soils near the west edge of the proposed bed, which indicates that effluent should be able to readily percolate downwards through the soil. There is no confining stratum which would tend to direct effluent horizontally towards the west where it could daylight. Since the entire bed will be below the existing ground surface. there will be a barrier of undisturbed native soil which should be more effective than the imported barrier provided in a mound system which is allowed to slope at 33%. Also, since the bed is proposed to be constructed below grade, the effective horizontal separation from the sloping ground will be considerably greater than 5 feet. and we will do all that we canto maximise this separation. To provide further protection against horizontal migration of effluent, we propose to install a visquene barrier along the sidewalls of the excavation wherever they are within 25 feet of the slope. We believe that the existing system is failing due to the fact that it is grossly undersized. There is no evidence that this system has any tendency to cause effluent to daylight through the slope. The proposed system has approximately 3 times the area of the existing system, and thus effluent should have a much better opportunity to percolate downwards through the bottom of the bed. Were the proposed system not to be allowed to be installed, the only alternative would be a holding tank. This, we believe, would be a much less desirable alternative, in light of the fact that we believe that the proposed system can function within the intent of the ordinance and will not pose a potential hazard to public health. Please give me a call if you have any questions on this analysis. Sincerely, Ted Moore, P.E. cc- Susan LaGrande Flattop Technical Services 14530 Echo Street Anchorage, AIa,-Ica 8951r Lot 4. Block 2. Park Place S/D 16710 Stone Ridge Road Septic System Upgrade Specifications and Design Notes 1. The scope of the project consists of abandonment of an existing lift station and soil absorption drainfield. and installation of a new package lift station and construction of a new soil absorption drainfield. All construction practices and material specifications shall be in accordancewitb Municipal and State requirements. 2.. The project shall be constructed as shown on the site plan and design drawings, except that minor modifications may be allowed or required by the engineer conducting the inspections. 3. The proposed configuration calls for the edge of the soil absorption bed to be as ?close as 5 feet from the top of a natural hillside -which drops off to the -west at slopes tranging from 25% to 60%. This configuration is necessary due to the extremely limited aiea on the lot which is suitable for construction of a soil absorption system. The entire remaining portion of the lot. located north of the residence is poorly drained, and subject to a shallow seasonal groundwater table. A waiver of the normally required 50 foot !setback from slopes in excess of 25% can be justified by the fact that the measured perc rate in the surf icial soils adjacent to the slope is 5 minutes per inch, indicating that effluent will be able to readily migrate downwards through the soil. rather than having a tendency to migrate horizontally and eventually daylight through the side of the slope. I 4. A waiver is also being requested to allow construction within 5 feet of the property line common with Lot 3. This waiver is necessary in order to'maximize the use of the limited suitable area available on the lot. Granting this waiver will not affect the potential for future development on Lot 3, because the configuration of the driveway precludes septic system construction on the adjoining portion of Lot ' ). 5. The soil absorption bed has been sized on the basis of 37.5 square feet per bedroom which corresponds to a perc rate of 30 minutes per inch, despite the fact that the perc rate measured at the test hole is 5 minutes per inch. This oversizing is believed to be prudent based on several soil tests done nearby by others. indicating significantly slower perc rates. and also based on the the observation that the existing soil absorption system appears to be significantly undersized. The purpose of using an average perc rate of 30 minutes per inch is to compensate for local variations in soil conditions. 6. The existing septic lank is to be retained provided a new cleanout is installed giving access to the second compartment. but the existing lift station is to be abandoned by removal of the mechanical equipment inside the housing, and then crushing and backfilling, or otherwise properly disposing of the lift station. A new package lift station Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 (Orenco, or equal) is to be installed in a 500 gallon steel tank at the location shown on the site plan. The lift station tank shall be equipped with a watertight manhole riser extending at least 6 inches above ground level. 7. The new soil absorption field shall be configured as shown on the plans. The native soil base of the field shall be achieved by stripping any fill overburden plus the peat and sandy loam strata to expose the top of a gray silty gravel stratum. Due to a 7% slope in the area, in order to achieve a level base, the depth of the excavation will vary from approximately 5.5 feet at the south end of the field to 2.0 feet at the north end. The use of sand or retention of undisturbed native sandy loam in portions of the field may be necessary a achieve a level base. lin the area where the new soil absorption bed overlies �the old one, the sewer gravel and adjacent contaminated soil is to be removed and placed as fill along the west edge of the new soil absorption bed. The area from which this . material has been removed shall then be filled with medium sand to achieve a level surface at the same elevation as the remainder of the bed. The portion of the old soil absorption bed which is not affected by construction of the new field shall be abandoned in place. 8. After the base of the soil absorption bed is prepared, a total of 12 inches of approved sewer gravel shall be installed. The pressurized distribution piping shall be installed level with the bottom of the pipes being 8 inches above the bottom of the sewer gravel. The line leading from the lift station to the soil absorption bed, and the manifold along the east side shall be 2* dia. schedule 40 PVC. The distribution laterals shall be 1.25* dia. schedule 40 PVC with 1/8" dia holes drilled in the bottom side on a 24" spacing. The holes are sized and spaced to achieve even distribution with a 4 - 5 foot residual head given a 34 gpm output of the lift station pump. The ends of all laterals are to be capped, and all joints in the pressure distribution network are to be glued. 9. The top of the sewer gravel shall be covered with approved filter fabric, and insulated with 2" thick, approved, burial type insulation, The insulation shall then be covered with unclassified soil to a minimum depth of 2 feet. The surface of the cover shall be contoured and sloped to direct surface flow away from the soil absorption bed. Fill slopes shall be 3:1. 10. The owners shall arrange permission for access to the construction site from the owner of the lot to the south. The contractor shall be responsible to obtain new utility locates as needed. 11. A total of 5 engineering inspections will be required during construction: (1) Initial stakeout of the bed .(2) after the base of the bed is excavated. but before any fill mhterial is placed. (3) after the base surface of the soil absorption bed is prepared. (4) after the sewer gravel is in place and the lift station is installed, with all the piping connected up, but prior to placement of the filter fabric or insulation, and (5) after the final backfill is complete. (W -it- WELL DR%VE W.4y 1 � SEPTIC. S'rAKbP)FC -Hattop Technical Services 14530 Echo Street Anchorage, Alaska 995165 OF Az O;k�: lv� 4� Ar % 4 1 4<' OH 0 .. . ...... ... .. ..... IV 6 YZ.. -.. %THECIDORE I. A40ORE jr �-. CE -3589 Ar v IV Air Al EX%STit4G 10co GAL f-Epric. TANk NEW 600 6AL *TANk WITH 01keNCO LIFT STATION EXISTIN6 LIFT' fjA-paq 'TO 13tF 48ANI�amrb E)"s?"I(I SOIL ARS get, '10 99 AsAmt�DgEj� rRorosEb SOIL AIRS Utcb LOT E RANSOM RIDGE S/D 0<-- SEPTIC. STAKOP)PE CI T- 'Yj C 1-0 C fr 2., PAR PC PLA CE -S C-- PT -1 C Sl�-CT-Hrl C.,(p6:aA0c- 9 IT-J!F P1,4N SCA LI5- 01z 3o' DA7-,w 1? /90 DWH ov,: TFPI Norc-:.* T -H(4 ii moT A SuRvc'roo FI -Ar - /f L.1- I-OCA77:2AI-r AIL6 4PPRoAst�Arc- elfc4ATION 2 M.'r. WACLASSIFIEb FILL 7 NAriva S14rto 6:11AV01. I (,"SEWER 6RAVEL I I -r0TAL BELOW DIST. PIPE SEWER GRAVEL SECTION "A -A Flat ! to P Technical Sefvlces 14530 Echo Street Anchorage, Alaska 9951p, 01: 4 . %P;er % 9 6 0 6 . . . . . . . . . . 0 ............... .......... THEODON F JAOOR- A CE - 3i87 � AF Ar OR16INAL ISRADE u4suLATIOM (2.0� FILTER FABRIC LOT 4j BLY,2. PARK PLACE ABSORPTION BED PLAN Alit) SEC-TIOK SCALE' I" = 10 DATE 4 9 ho DWR By, % FROM LIF 0 M.T. 20 3 0 x 'A I I "Am In tu 'a V %A I W IL iv 0 -T PLAN VIEW elfc4ATION 2 M.'r. WACLASSIFIEb FILL 7 NAriva S14rto 6:11AV01. I (,"SEWER 6RAVEL I I -r0TAL BELOW DIST. PIPE SEWER GRAVEL SECTION "A -A Flat ! to P Technical Sefvlces 14530 Echo Street Anchorage, Alaska 9951p, 01: 4 . %P;er % 9 6 0 6 . . . . . . . . . . 0 ............... .......... THEODON F JAOOR- A CE - 3i87 � AF Ar OR16INAL ISRADE u4suLATIOM (2.0� FILTER FABRIC LOT 4j BLY,2. PARK PLACE ABSORPTION BED PLAN Alit) SEC-TIOK SCALE' I" = 10 DATE 4 9 ho DWR By, % Or, A Flattop Technical Services 14530 Echo Street ............... AVJML;Wj?y jjGA%agqqslG DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street. Anchorage. Alaska 99502-0650 JAC)ORE ete,'... CE -3587 .-*s�-A L:r .9 SOILS LOG 44, Q .......... PERCOLATION TEST A � I PERFORMED FOR: SUSAN Lr6RANt) DATE PERFORMED:-- 8 120 /go LEGAL Township, Range. Section: .5ec. �, 7'1/ N, I? 7W 10— WAS GROUNDWATER ENCOUNTERED? NO 11 IF YES, AT WHAT 12- DEPTH? 13- Depth to Witt( After Monitoring? . DRY czit:-S�c 14- fFEET) GM— FILL 11 - Not Drop 6 PT ASH Is- 2 - 17- 5:08 SM SA19DY LOAM 3- WITH COBBLES 4- - POCICETS or 6W 5- 6M /ML 6- YX SANDY SIL�y 6RAVEL 7- DRY 4 LOOSE NEAR TOP INCIRZASINGLI I10ISr 4- 8- 22 *y/1 COIANCTEb W- DEPTH 94 .5. 32 0 0 10— WAS GROUNDWATER ENCOUNTERED? NO 11 IF YES, AT WHAT 12- DEPTH? 13- Depth to Witt( After Monitoring? . DRY czit:-S�c 14- Date Gross Time 'Wet Time(mlsq) 15- Not Drop 6 Is- 27 V't 17- 5:08 18- - 14-2(0 19- - 20 - Reading Date Gross Time 'Wet Time(mlsq) Depth to water Not Drop 6 IVIII5, 27 V't 5:08 - - 14-2(0 - 22 Yq YX so 23 Y -t 9"41 1to 22 *y/1 Ego .5. 32 0 0 23 Y -t 3 !9%37:00 22 V� -114, 0 S' .37-.30 23 Pt # 4 51 q 2 '. 3 0 22 *7/ff, PERCOLATION RATE (minutestint:h) PERC HOLE OIAMETER 'Z TESTRUNBETWEEN FTAND S -2f FT COMMENTS MT. INSTALLED PERFORMED BY: F--(cet&e Te-cA Cver CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 911119c, 72-008 (R". 4/85) NEMA Rot dia C PtM 90 T Ydia 21 'Z 24' x: 4' 6' Culvert MaMote V Flexible Pressure Hose L' P V C Pipe Typ I" Urethane foam (shop appU oth Toemec top coat Ndjustable Float Switch AssG Seat wrbh RAM-NEK or EquoA J --boli hold clown I t/4' welded coupl.�xg L/8' Dr= Back Hole 4'pvc: f tow inducer I 3/e' holes 6' OC 1/8' mogh polyeihylene scre, 151 d1a x 3c�' high L/2h.p. U.L. I-Ested Submeristbl, Effluent Pump Retaining wigle-s 500 GALLON LIFT STATION in ISO LM IM 500 GAL Rislarve CO-p=tY above Ato*M U 1 gal capacity i3etween �Ip of f Pump on L Pump Off 4� 123 got DOSE: - Float Levvt 90 d so I Alarm 79 so Bat -tam L— so 40 eQ 20 to 500 GAL Rislarve CO-p=tY above Ato*M U 1 gal capacity i3etween �Ip of f Pump on L Pump Off 4� 123 got DOSE: - Float Levvt Ceotgr Float Cord Ai Settings jIt Above Vault I Alarm 39 - 31,5' Bat -tam L— = STATION DATA GoltorLs per minute TYPICAL PUMP PMFMRJWiCE CMVE: z li"�) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH& ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT N IPHONE V-UEUY_ OUPGRADF MAILING<RgS R,*5" LEGAL 0 RIPTION rec 7- A LOCATION NO.OFBEDROOMS Well Absorption area Dwelling PERMIT NO. DISTANCE TO: Manufacturer Material No. of compartments W Liq. capacity in gallons IF H �EMADE- Inside length Width Liquid depth le DISTANCE TO: Well Dwelling PERMIT NO. -10Z 0 2 - Manufacturer Material Liquid capacity in gallons 0 well Foundation Nearest lot line PEHMIT NO. -1 W DISTANCE TO: W M No. of lines Length of each line Total length of lines Trench width Distance between lines -1 W Inches CC 1- Top of tile to finish grade Material beneath tile Total at Inti ve absorption area Cl inches Length.2 Width ,s Depth I PERg:T�O. W 0 Crib dia Crib dep Total effectn,�IbE,:!�n Well - Buildih�,foydation Nearest;lp I DISTANCE TO: 1j)014 Class Depth Driller Distance to = MIT NO. .j Building foundation Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIAl S 6gs?- SOILTESTRATAG K5- V� -A -N I INSTALLt),,d, oil REMARKS In All DATE LEGAL V-2 4 sw --:� I 72-013 IV 3178) INSPECTION REPORT m�llql&PALITY or ANCHORAGE, BUILDING SAFLTY DIV10100 3500 EAYT TUDOR ROAD INSPECTJONS (907) 563-3464 ADMINISTRAIION (VO7) 786-b2ii NAME: OWNER, TR4300.6 PERMIT NO: 03-4811 ory yvnmrpTnrE ROAD PHONE 345-5026' SI"LLI "MV0 LEGALI PARK PLACE ADD V LOT 4 BLOCk 2 I CORRECTIONS ESSCNTIAL Af EXPLAINED COMMENT; DATE- 0506/04 ADOVE IN2PECTIONS REQUESTED- ELECTRICAL ERRORS: 2w LLEC FlPAL ANSPECTIOn 14,1'VINAL INSPECTION APPROVED el- FOR ----- DAYS �OA�l f'INr%L rINIEll TIriE://'L'Z FINISH MILEAGE! STAR'l - f I h 171/0) START MILEAGE: T015 DISTANCE: 1 H � P E C' r 0 R. 4��V-2 A WHEN cokunrloos, RE MADE, PLEASE CALL FOR INSPECTION. '563-3464 DO NOVREMOVE THIS YOTICE (;(-J�IMENTS 00 NONCOMPLIANCE QBSERVED I I CORRECTIONS ESSCNTIAL Af EXPLAINED ADOVE 1 WILL QEEXAhINL AT NEXT Do NOT CONCEAL UNTIL REINIPLCTED ANSPECTIOn 14,1'VINAL INSPECTION APPROVED I I APPROVED CONDITIONAL FOR ----- DAYS f'INr%L rINIEll TIriE://'L'Z FINISH MILEAGE! STAR'l - f I h 171/0) START MILEAGE: T015 DISTANCE: 1 H � P E C' r 0 R. 4��V-2 A WHEN cokunrloos, RE MADE, PLEASE CALL FOR INSPECTION. '563-3464 DO NOVREMOVE THIS YOTICE ,�UNICIPALITY OF ANCHORAGE L) Department t Health and Environmentae'C �_�Co AK. 99501 825 Street, Anchorages 2 -4720 64 HANDWRITTEN PERMIT 'C.ID "-rl- P I ermit # WELL ANUAJ!F ON-SITE SEWER PERMIT (?Sb;7 Applicant: I—S-4—L-L-k—itt-mailing Address: Se fi /S 6-V c/7 Location: Phone Number: Legal Description: t� �, L L/ Ab r-/,/ 12tO 0 e Lot Size: Type of soil Absorption System Is: Trench: Drainfield: — Seepage Bed: ��olding Tank: Maximum Number of Bedrooms: 13 Soil Rating(sq.ft/br) 9 Is Required Size of the Soil Absorption System Is: 4 DEPTH LENGTH _ GRAVEL DEPTH WIDTH The le ion is the length(in feet) of the trench or drain depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall Pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * ' * TWO(2) INSPECTIONS ARE REQUIRED Backfilling of any system without final inspection -and a�iroval by this departmer will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fef for a private well or 150 to 200 feet from a public well 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 required and must be returned'to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 8 3 I certify that: (1) 1 am familiar with the requirements for on-site sewers and wells as set forth by the municipality of Anchorage. (2) 1 will install the system in accordance with codes. (3) 1 understand that the on-site sewer system may require �nlargement if the residence is remodeled to include more,,that 3 e rooms. Signe'a: issued by: Applicant Date: SWP/024(1/81) 0_Zj_, _1� ct. o-77 7 L/ SOILS LOG MUNICIPALITY OF ANCHORAGE IT' PERCOLATION DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 0 TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 I * SOILS LOG - PERCOLATION TEST PERFORMED FOR: /f,/ DATE PERFORMED: Vzz,/t- LEGAL DESCRIPTION: 41,97- 4 ie`54�e Z 0`4-41e lf,e4645 -5-fl&ZVV227Z� A22-5 rD—E—P—THI SLOPE . . SITE PLAN . I eCA4,Vla A 2- t 3- 4- 611-7--V L57C-11VC41- Aww 5- 0. 6- . � 7-0 8- 9 f 10- WASGROUNDWATER 11 - ENCOUNTERED? 12- IF YES, AT WHAT DEPTH? 13- 14- 15 - OF A 16- 17- 49TH % 0. ear ot ;,*Ib.W B sh E 5 3 91 '0 jr 20 I PERFORMED 72-008 (6179) 3 L E Seeding Date Gross Time Net Time Depth to Water Net Drop /Z -JP 7 7:050 rj0`1 7j� 'a it PERCOLATION RATE 14Z (minutes/inch) TEST RUN BETWEEN 70 - FT AND 0*0 FT I �I- -*j^ M IED FA MUNIC - IPALITY OF ANCHORAGE DEPARTMF-1 6i'll AND ENVIRONPAENTAI oft, 10TECTION PERCOLATION TEST B2, L. Slo.,U Anchotaps. At.%Is 99501 2&4-4720 SOILS L'O'G'- PERCOLATION TEST PERFORMEb FOR: —DATE PERFORMED:. ,,LEGAL DESCRIPTION: r1_)E P -T H I SLOPE SITE PLAN I EET Y, B Q,- W PJ Pk -r A T P T — — — 2- F-ComjEf'.1 -ro Z.0 3- V M , X1 ot . 5-r _l \Nr—T Or_OoJN6iLT%4 &1Z.AvEliLlit-,16AN0,6M, WC7 7- _j -1 ,pnoc.w r.,cry sill &RAVA�4 lo� /4 1 All 7a -rA 7*VrZ47eD 10 A7` o/v _-z7c/h1 IL WAS GROUND WATER S ENCOUNTERED7 L a P DEPTH7 P,g IF YES. AT WHAT E 3 op-iii.nmr. =4,-rf G In14- 6 AND, GM �AT 16 In 17-4, Is - '6 10 18 =T0-MLJD:5PTfA OF 2-0.0 ' PERCOLATION RATE (.*.n.t "Anch) PVC INtTALLF-0 TO '2 , 5�' FT NO I C7 .0 TEST RUN BETWEEN A FT OPAMENTS I ERFOAmEDBY: PETE 0-YAL-Intj rt- —CERTIFIED 6 MEN Effilmoomm OMEN - IN ONIENNE—Emm momm MENNOMEMEN momom EmEmmommmm 01 NO EIREMANNINININ sommommoom Sommommomm NIMMUNEININ W KA m MEN NONE I Pi I P, sup N L14PW460890000 OW .�20 Smommommom 0 Effilmoomm momm momom EmEmmommmm DATE: -6-i Ir e .2P MUNICIPALITY OF ANCHORAGE PERCOLATION DEPARTME * (bF HEALTH AND ENVIRON'MENTAL I JITECTION TEST 825 L Street. Anchorage. Al&&" 995DI 2644720 SOILS LOG – PERCOLATION TEST I IfERFORMEb FOR: -Tiz#Ai> triaimr-rRif4r, —DATEPERFORMED: L EGAL ESCRIPTION: 15-rrt4r-- 91par, -qt) RrtjVl_e�joa -rr�5-T Not F=-AV4 PEAT.APT.01Z&ANIC. MAr SLOPE SITE PLAN 4-Awf-IJ-V 6APJO,--,M, Mol:5r 1 9 10 a 11 12 - Gross T;mt Not 7-Ime Depth to Water Net Drop 1 4116107- mulummm 13 MENIN 14 - q.?_1 AIA So 15- =1010 11:10 MEN PJA 16 - 1216 .'W--- B12.0WN SAND' f a e A v F- L,�Go, P �-C, Pml� 7 -.w7-W mo MEDIUM mommommomm, 4r, I I 16 13 9 'A 1. DE!,16sref I SZ& 1 9 10 a 11 12 - Gross T;mt Not 7-Ime Depth to Water Net Drop 1 4116107- mulummm 13 MENIN 14 - q.?_1 AIA So 15- =1010 11:10 MEN PJA 16 - 1216 17 is 1 19 01.,MENTS_ 42— I" Dev 6LOU&A -T077'fL. Df-p-rk of scoltjc, 1'7.0' uERFORMEDBY: ( '�7L�A5Z-- '. 72�oog 16/79) Li WASGROUNDWAT ER ENCOUNTERED? IF YES. AT WHAT DEPTH? E t �jj Nil Gross T;mt Not 7-Ime Depth to Water Net Drop 1 4116107- mulummm MENIN -no q.?_1 AIA ON , =1010 11:10 MEN PJA 4 1216 mmolmlomm ()Ry 1412116 mmommummom I ZZI mommommomm, 4r, I I 16 13 9 'A 1. 4-"Iff- I SZ& 4-4/4/42- 4 J/p NEENNEENININ 4 ( Ne 16 '/1 C, 1:.36 44 31+Z41�tjr NEEMENNINNE 1,4-1 .4-5'14T413/6 3 L5/1 1:4�G --+55A NINENNNINNININ SAINENNENININ mommommomm mommommomm 0102whommom WE mummmuml t �jj Nil Gross T;mt Not 7-Ime Depth to Water Net Drop 1 4116107- mulummm MENIN -no q.?_1 AIA nV 3 11:10 mmmmummumm PJA 4 1216 mA ()Ry 1412116 mmommummom I ZZI 4r, I I 16 13 9 'A 1. 4-"Iff- Read;ng Date Gross T;mt Not 7-Ime Depth to Water Net Drop 1 4116107- 1:013 NA 7- q.?_1 AIA nV 3 11:10 ng,'1/4-1'/?- PJA 4 1216 mA ()Ry 1412116 6 .. I ZZI 4r, I I 16 13 9 'A 1. 4-"Iff- I SZ& 4-4/4/42- 4 J/p 1131 4 ( Ne 16 '/1 C, 1:.36 44 31+Z41�tjr 1,4-1 .4-5'14T413/6 3 L5/1 1:4�G --+55A 4 PERCOLATION RATE nz Wnul"Anchl TEST RUN BETWEEN 'A - ZE FTAND 4.0 FT &� �E: AI,,/Ck7 � <-== - 1 -1!! t I t V= /.. ll� CERTIFIED ;:�Tz 3 ..... b1z Zf zf -Zs C/3 LAJ C LU ts. — t f C-3 u CZ) C: Cn ov+ U cc w Im 0 CL V, Z4 & = w CL Z-51 Ac. 0 ca c '14 Lr BLOCFi 2 C, cl 7 C; c .6/ AC. 0 tf) 0 0 AC. Im w.t. ca ca Do 0. 1/9 AC. cm do a 4f ox -V cu ttp'�-f to Vi "4 T, .56, 7 $4 4C. 0 LO ra tp r- ce 4J LO fo %- u ca 4J 5.50 Y/,. 0 V-5 A C. 1. 00 AC. 41 m u tm 7.13 2 P. /..10 AC-. cm F ea C 4.5104 SJ� I gn S -Z I.W AC. 0 Z-5.14, co 1� �(SbG;A- C% CD OL 0� C( bck :Ztf x 4,L3 -;t7r q(.1 Gut Dz df JDZ wr2ql De Y4' L �/-� 3 �P- L-5 X wal-yv- if, j il"o 4 fP u IP q t ttl.� a C7 ro� 7 ' �10' —5 * J'.' w CvtvMr ArwP U,-vb-L. jQavT ALL� .67i:.AvE.L Atio Pit -A) Q rCWA11VC , 10 Mt- S'Ljofl-fer- TO Aez4OA4CPJ clot V�E-w V, ,--2.4FM 7-101V L-RUCY- VAIoIVC* Vmp CouTul. CjAM9 VALVC kx Tb vou" Aj 'Pc� f- -17-10 4/ —.- 71 Popv grvwc?AoJ7-&v -Z tAl ec-D CA VY'6106, TV VI6ruftivoic, -I-cc-S ec"CT-vir 406't Coal. 006 Gm- nc� txNVL I M. F GAL ox PUMP-ZOSVeJL VZ" CLLffl'rleIcjmFjtwAY r"^r Wir W1 GM V U At'?3A, a H AtTUKN 70: 0 "I'l" of Cool-91cal -S) STATE OF ALASKA DEPARTMENT Of NATURAL RESOURCES 31,01 Porcupine Drive ho.01 277-661S) A,,chorsqq, Alaska 99501 I w A I f A W I L 1! C 0 A 0 Vern s' Drilling & E�n t U ING. Drilling Company Nams Ori'll'InIg PI.y.11 No. OCATiom OF I-XLL - Pleale cn-plote either 14, lb, or It. A.D.L. No. Is. borough Subdivision Lot Block lb. Fraction section No. IdI4n Anc , I Lj 1 2 1 / / / CTIWMor It. Distance and Direction from Road Intersections OWNER OF WELL: William Strickler Address: Stonoridee Road Str,,t Address and Area of Wall Location 77�1,ott (Go -Ole 4: WELL DEPTH: d) SurfA Ic ationj Date of 2. WELL LOG 220 I le I Ion 77A 3 . , material Type Top f7 -- rray cilty seepare 1 0 1 15 1 S. OCablo tool 4�jkot,ry 00ri.s. 00-9 —Drn MIN T.I.E.I. 1 15 1 55 1 0 Auger 1:1 Jotted 0 bared 0 Other:— (seepage 291 =4 51 1 rpm) 6. USE:X E] 0,,eas% Ic 0 public Supply 0 Industry. rra blue-decompn-ind rod- cr; C; 0 IrrIg4clo" 0 Roche rge ocommort let rray rock h-ird -f2 I 4-, r OTest Well 00thor: Ptrnnl— 0 wh j t L CASING: 0 Threaded NZ) We 1464 r,hjt-j,. rnr-1, afraakz--,S� f A in. to t. Depth Weight ibs/ft. V;r,�M A PIRO I r —1 n. to ft. O*Pth a. FINISH OF WELL: —,.ull prOullcus > gpla / ef Type: Olamater!- 91ad-C �4� $lot/M*sh $Ile: Longtht Set bat�en ft. and ft. FAttings: STATIC WATER LEVELI 1101 ft. Above 1310a. land surface Type of Measurenent: 10. PUMPING LEVEL balorr land surface Lo ft. After Mrs. pump 102 _ 9 -P -m - ft. after Mrs. pumping —9 -P -m- 1. WELL HEAD COMPLETITN-- C1 In. Approved Pit 1 it. "ELL wj Fitt*$$ Adopt,, - Inches above grade 12. GROUTINGt Wall Grouted: Uyes XE]NO 0moat 0 Other: materiel: Cement 13. Pump$ (if available) HP Length of Drop Pipe ft. Capacity — I -P -A Type: CIS,bmerSIble C]ReCiprocatlng C3 Jet 00thert 14. REMARKS: Water TeriDerature: 15. WATER WELL CONTRACTOR'S CERTIFICATION: d,1,1,1.j under my jurisdiction and this report Is true to the best of my krKholedge and belief: Ala_ ,I . '�nt �1, -VernIc Drilling & L 10 C._. ell AA 3327 O.S1.41s S.� Contract License N.�oer Address: Star Route A Box 1560 Anchorage, Alaska 99507 Signs d ; Date: e-21 1�'. Copy Distribution: WHITE - State D&GS, PINK - Driller, CA!1AAY o Customer • • 6 1 8 9 70 E B4 •, l' Municipality of Anchors : „ '' °t� " . On-Site Water and Wastewater Progra -r, : -:•C .o4 1161j1• . `• (907)343-7904 ETT , JUN 2 9 2017 1N Certificate of On-Site Systems Apo •. w `4! • c)� Parcel I.D. 020-092-62 Expiration Date. s ` er — 1. GENERAL INFORMATION Complete legal description Park Place #1 , Block 2, Lot 4 Location (site address) 16731 Stone Ridge Road Anchorage, AK 99516 Current Property owner(s) Steven & Carol Ramsey Day phone Mailing address 26532 Johnson Lake Lane Detroit Lakes, MI 56501 Real Estate Agent Carla Nice Day phone 242-2427 2. TYPE OF DWELLING: El Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: Three 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual El Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by: , .- Date: COSA to be released (� .(,the engineer,unless othe ' e req estednby gineer. VAA COSA Fee $ So 315 Waiver Fee $ Date of Payment 4(- 3111 ill JI JI-1 Date of Payment Receipt Number QlLi(P1 Gl0 L�3 �1 _ Receipt Number COSA# 05C...111211 I Waiver# 1 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Anderson Engineering Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 6/29/2017 4sI.tf1 �•oF° 4�S°oe 0,6%. 4g?H to .* 6. DSD SIGNATURE " System #1 Approved for `7 bedrooms .MICHAEL: , ANDERSON : Dd System #2 Approved for bedrooms * rsl��.,.EE Zq 43$1 ,.•.��" • Disapproved >7 ROFESS\O � `�� P �A�- Oo Conditional approval for bedrooms, with the following stipulations: y I1-i S t C i S �� '1 eay'C i AP le t3 261 eakir cQ - ; .10 �` ( OF ti��yG, j ON-SITE 6, s WATER AND `� 9-1-A WAS(EWATER FROP,RAM rcp By vw, Original Certificate Date: 7rt The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X _ Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheeti: : c If more than 1 septic system is on the lot: COSA Checklist# of Structure served by this system Certificate of On-Site Systems Approval Checklist Legal Description: Park Place No. 1 , Block 4, Lot 2 Parcel ID:020-092-62 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (YIN) Y Date completed 6/83 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y Total depth 220 ft. Cased to 220 ft. Casing height(above ground) '12 in. FROM WELL LOG AT INSPECTION Date of test 6/83 6/28/17 Static water level 40 ft. 18.2 ft. Well production 5 g.p.m. 3'1 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate ND mg/L Arsenic ND ug/L Date of sample: 6/15/17 Collected by: And. Engineering B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/Steel Date installed 9/28/83 Tank size 1 ,000 gal. Number of Compartments 2 Cleanouts (Y/N) Y Foundation cleanout(Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 5/2/17 Pumper Isaacs Pumping C. ABSORPTION FIELD DATA Date installed 10/17/90 Soil rating (g.p.d./ft2 or ft2/bdrm) 375 5F/BORN System type Bed Length 45 ft. Width 20-30 ft. Gravel below pipe 5 ft. Total depth 4-7 ft. Eff. absorption area 1,125 ft? Monitoring tube Y Depression over field N Date of adequacy test 6/28/17 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test 0 in. Water added 450 gal. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate >= 450 g p d N Any rejuvenation treatment(past 12 mo.) (Y/N & type) If yes, give date D. LIFT STATION Date installed 10/18/90 Size in gallons 500 Manhole/Access (Y/N) Y "Pump on" level at 28 in. "Pump off" level at 24 in. High water alarm level at 34 in. Datum Bottom of Tank Cycles tested 3 Meets alarm &circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot >1 00' On adjacent lots >100' Absorption field on lot >100' On adjacent lots >100' Public sewer main >75' Public sewer manhole/cleanout >100' Sewer/septic service line >25, Holding tank >75' Animal containment areas Manure/animal excrete storage areas SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5 Property line >5 Absorption field >5 100' Water main Water service line >>10' Surface water > Wells on adjacent lots X100' ABSORPTION FIELD ON LOT TO: 5'** >10' >10' Property line Building foundation Water main Water Service line Surface water >100 Driveway, parking/vehicle storage >10' Curtain drain None Noted Wells on adjacent lots >100' F. COMMENTS **Lot Line Waiver issued 1/10/91 . G. ENGINEER'S CERTIFICATION 0061101k1it1I I certify that I have determined through field inspections and `��,� •• ..q 4e review of Municipal records that the above systems are in ••'` • /, -.1-- * conformance with MOA COSA guidelines in effect on this date. a*'• 4 Tk t'..,\ •:* I Michael E. Anderson, P.E. i••• •••• ••• •• ••i Engineer's Printed Nameh•• Date 6/29/2017 f jO.,..MICHAEL E. ANDERSON.-,.c. s'.• CE-4381 ••g� il 11 s COSA brown sheet 10-10-12.doc r 81 70N • 1111 III .. dl ,, III ti a'd'AI '111 111,1 11 11111 111,1 IIIII AZ. 1 111111 111111'1 111111 1 ►,Vl 1 III •^,•' 11 �. ti phi 111 (III CI in. ^j �►� 1 11' y, a� ' II 1 1 I 1111 Q. 1111 CO' �• ._ 11,rCenhaa iant 7 L:reek WUlrrl_Ea:arrwrr: 111 1 --, 11 111 a �-�.1 r'' al -� 11 �- t ..- L11 .9 1 1' i II II 1Iii 1 _ I I r f II II 11111 ` �M�1 J I III 11 111o - 1 111 111 ' q1 111 ,' E II 11 II°III iI LOT 4 w 11 111 111 1j+r7 I 111 o I 'N. III L 1) '111' II 111 L.1 11i1 • II_.---- II LT 'N III — T, 43- b o �� N fl ,I, '� `. .� 1. 1 CheirllirN:renra., 1 1� w 11 111 111 'x'III . ' I I s eD V III 11 II 1 11 V Gaarra►ge•n II III 11 ' II IIIA : . `'`II — I 40 III .. 11 II o ilt III ito I, - I II Paghvi 1 `' o .11 II, -. ( r o �� 1f _ II z Io -w. .- ar��11i r = • I:i'raralell rflPr,latM1 '� .,� r II _ — " LOT 6 IIII un @da' 1 ' 29141— ....., uunrir I., 2 1,12 SIOWErr+114 11' iINN' LR r .-, Ransom Riidge Subd.. , T f -9:5. ~N. LOT 3 y "N • • ,, `., LOT 5 11 II • 11 RECERTIFIED ff:2H-1�' .AS-IB1MILT itg3 CORNERS SET THIS CATIE: I ..^0,,''.'1'4, herteb�l aeaniih�''haft II Mama Faelrrl'emmaad ar r�lanfgage+eas Magadan! IIII �►"' ILf 11,� ,aFthe bliemiing described IRmapatitt�l: WT 4, BLOCK 2. • 0• .�� , ,. • • .'L •1 PARK PLACE S UIBIDIrdIISIIIIII'�I. ADDITION No. 1 1 • e1,. i�,a� s ''�.I'• .; 9 tihi ,, 11� ,Ivmcihorage Recantling Eisrlrirt,Aiaeril a,;ant tart Ii$Te 1°7*. .* i itntrowertnarths ablated iheneori ale'a Linn the;>mopartrnp Ines. • and del ma overlap dr encroach;cm the property tr'irtp a«�. F .adjacent Wiener!,that no&comma:mants art 1tr. prccer!,'t,rin3 �. . Wilmot - .adja,nent Uhenan°emsnuach lam Me premises.In quw_stlrar;anti T^ .Brett hi A.. .« / chat there are ms mnaa>ttr,arA ,dramse tiasibn Ines car titer �� .« tll' ;�,- «•� 'visible ecasrsrnerts•VI said prcper-hi�eoiaeprl:;as nrh ahad a,`. hareem. S'CA1LE: 1m-= 410P 1 d. gr «., ""' •� Dolled.at ',rii icrxlge,Alaska `15autn+w'. ,ate. This ;5111h torpor cr< Seabetmlber, 'M E�,;51E1 IEr�flS OF RIEC'CIRID„OTHER THLArrll �,%.‘11041006. THOSE•SHICrAN ON THE RECORDED FRED ViVolLasliK4,al.ASSOC A.?rEs • PLAT'ARE INacnr SHOWN HERErO1N.. iEmglineers anti Swrpowerms IFB e.-2, xi 35-36, BE 1907-248-19561( 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 9951 M650 www.ci.anchorage.ak.us a (907) 343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. o7o-n92-62 HAA # CX,50zle Expiration Date: 1. GENERAL INFORMATION 4n:. S. 1 9 1 V Complete legal description Lot 4a Block 2- Park Place Subdivision #1 Location (site address or directions) 16730 c;tnnp Ridgp Rd- Anchorage. AIC qq';16 Current Property owner(s) Vince Watson Day phone 230-1925 Mailing address same Lending agency Day phone Mailing address Real , Estate Agent Day phone Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well Ey individual Water Storage El Community Class Well 11 Public Water System 0 TYPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site 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 engineers 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 adequatd 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 S & S Engineering Address Engineers Printed Name 5. DSD SIGNATURE Approved for Disapproved. Conditional approval.for Additional Comments bedrooms. Phone 694-2979 �iver, AK 9577 Date Z2 bedrooms, with the following stipulations: : W�i�WAD * -VFnQ1CVVAJLH - z Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineers Report Other By: Original Certificate Date: (R@�. 01J02) Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6660 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST' Legal Description: LOT- '13LOCJ� �Z' C—) C--) ParcelID: 02-0-0?2-42 , rpwx -KLW-e 4b" I A. WELL DATA Well type��tv*TE_ If A, B, or C provide PWSID # Well Log M*N) Date completed 6 65 Wires properly protectedON) 12114 Sanitary seal6N) Ltts Total depth i�qLft. Cased to _9a�!Lft. Casing height (above ground) in. FROM WELL LOG AT INSPECTION Date of test to WV3 Static water level tic) I Well production 9 P.M. 9.P.M. WATER SAMPLE RESULTS: Coliform colonies1100 MI. Nitrate to / mg.n. Other bacteria C) colonies/100 mi. C '5'0"S t5qkEkX-ce1P_)6 Arsenic: mg./I. Date of sample: :4-06/0 5 Collected by: B. SEPTICIHOLDING TANK DATA Tank Type/Material 5z -FT -14. It STZ;C-c Date installed Tank size /006 gal. Number of Compartments Cleanouts (YN) Foundation cleanout MN) � Depression over tank (Y/M High water alarm (Y4D Y__'50 Date of pumping -5 Pumper /( J �Ps C. ABSORPTION FIE TA Date installed 11D Soil rating (g.p.d./ft' ft2 /bdrm 15 System type 10-W—C <� I Length q5 I ft. Width SO - -30 A ft. Gravel below pipe 0, ft. Total depth 2 - q I V Eff. b orption area J.V5 ft2 Monitoring tube _�L Depression over field I`J Date of adequacy test _�q 05 Resultsd!!�PFail) 11'� For 66±:1 -2-Lbedrooms Fluid depth In absorption field before test in. Water added 4031 gal. New depth Cog in. Elapsed Time: AlOmin. Final fluid depth :3" in. Absorption rate >= q664- g.p.d. Any rejuvenation treatment (past 12 Mo.) (Y& type) K) 0 If yes, give date - — D. LIFT STATION Date installed 'Pump on" level at 315 in. Datum 3C=Vyl�- E. SEPARATION DISTANCES Size in gallons Manhole/AccesseiQ) 'Pump off' level at _11 k L43 It : in. High water alarm level at in. Cycles tested f;Z1 Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanknift station on lot. tZ4 Absorption field on lot (qq I Public sewer main 01) Sewer /septic service line_ 95'4 - On adjacent lots 00 On adjacent lots 1601+ Public sewer manhole/cleanout Holding tank to 'A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation Property line 36 Absorption field Water main "VA Water service line q0 Surface water Wells on adjacent lots 100 SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5 -X Building foundation 3L- Water main Water Service line Surface water —1 Oe;' 14 Driveway, parking/vehicle storage if) Curtain drain L309t, 'WeXCAJ Wells on adjacent lots F. COMMENTS r t ITIJ LV -117 LIME G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipat records that the above systems are J . n conformance with MOA HAA 9 yo . a . a 1. s i . n Me t o7tlte Engineer's Printed Name 7� Date /2 -2 - HAA Fee $ L4')* Date of Payment -7.1-ZT)o S— Receipt Number A-1 (Rev. 12101) UU I Waiver Fee $ Date of Payment Receipt Number M Q 0 W F- LLJ U) f-LLJ Fa -of ti N�3,LVYT 0 W (n U (n Z 0 Q W Q W = m ~ Lli = �+ W OJO 1 Li Z Q _ 2(in: 00 I F- Z O W Z_ I CO J Qa(n= z cn a 0 Q Q W J � 0_ F- Q O LLJ , Q W W' � Q W D > Z < orf F- � Z W Q= w F— 0 W Oz O Of C)W az- � 0 N F w= (n Q WF-I- Q Q 0 TZa- ILL W (n V) �F-F- m N I.- Z W (n L,.1 F-I-I- ( F- LLI W/) 0t,_0< z O Z W � I O /= S 00*02'41'`E____� n,'�� /��- i 10• UTILITY ESMT. cr) rn / ( / v r HJbg i tiji � 24.2' 0'p�� d3S .0'0p, <{` \ i (\ i— N < N N d O w I i \\ CARPORT a\ 1 \\ in X c0 \ w C N \\ \ w < /S' -`ry/} 100 O SET6PCK I 10 \ z 1\/S Z�/ SEPjIC 1 x 0 I C \ ` / z~ /441Id Li \ Z Z o C� O / ( Waw /t w TV,/ ui / d' W//�O U U i NULJ F //� /// Z,r$ 1' u W , 28„ E 157.65, � R=_12d.p5' S 08 30 466.L4' 38.5' 10.1 28.4• 0 Z W N j XO w= In O J _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ O 8 i w ^^ �C, 59.69' R=380.00' o 0 = En ~ M Dh JN, � `fit^ .: • • a ��5�� N AG O T � 0 o 0 0 c J oo O '• cn 1. -• �I t In v V� C A�✓C; {c : Z ,r z x w O® N z I x O I 1 N vW) CL ¢ ZO U N O I 0 3 J 1 Y I w �,� Q{� N 3 Z m¢ I z i Q a wQ W �1-aa�11U� U S > z an F W\ N m W> O o J ,n ri x 1., 0 3 c� ¢ d o rn i c w o -.oco 0 m~� CD c0� U C 00 a_ IOZy 70�0 c p= ,.. - 00 O i j 0 O := C 'y, W 0 d 0 N d Vi .-. C C)C O C.� W N 0 0 S E' T N U y J G N O D C O C D - Ld , N j C� C, II.. I C w O '.' �. .p 'p N 0 d O a�0 C LL 0 > 0 a J aEd i 0-2C O a _0 Z rn OOs W oo C N V U. 0i- i s 3 v rn oc �c d J 0oN 00 t�.r.. D y1p C V, O '- I D V 4, lil 7C-v, U y O'3'x W = C 0 0 O p, 0 i.o Ww aE oyoc'1° Cu Q v=io-vE Z V p C Z C C V O O_ S O O V J I L O N X I L C p w�#Z,u Z ul W Q 1= �w i >U 0 m_ d omw U w _ 11 oz Q Qr 0m T if N N W cp L M Z� CO WN coo J � U) � I � i x zoo m w 0 5 vvC3) a J L w I 0 w M n (o z M C ,: II - 00 u - x Lj >—u' ztttC) j 0 0 x nQ C) W; > N D m Q d m �z(Y 0 CO J oQ cY i Lea w 117 M Lj j F-Q z 8 W w J 0 ' 0 O 0 � G7 _ Z x Jd'Q o 3 N 40' r- 0 --q CA C� oor 0 — LOCATE PIPES— I SITE -PLAN C2 Qr V CO . Q. A) x rn En rn z 0 XOL t-3 al pt, L4 LG 0 '00-m:=8 Of .69-69 > 0 rq > 25 M in > tt 0 Z M C, A -4 0 Ln W r' a 0 0 C.) rn Ln > rnoo Coo -a C) 0 a) azo -<:b rn z t. rn (A m>w -< CA c z ,,S;>rr'. Z 0 z EA rn 0, 1 9:0 Ornwz OE-rno X Q M E;mo 0 Ex z 0 L4 LG 0 '00-m:=8 Of .69-69 > 0 rq > 25 M in > tt 0 Z M C, A -4 0 Ln Municipality of Anchorage Department of Health and Human Service! Division of Environmental Services On -Site Services Section 825 *L" Street Room 502 P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-4744 CERTIFICATE OFHEALTHAUTHORITYAPPROVAL FORASiNGLE FAMILY DWELLING Parcel I.D. 0 Zo - o 9 e - er 7- HAA#x496/-y-).a4/ Expiration Date: 1. GENERAL INFORMATION Complete legal description 1-o� V. Oloct� 2 r>c<r-k- Plore -C/b, A,.WWn, Location (site address or directions) I d 7 :r 0 S7�7^ e P,Peze Ro.�( 3r 4.r- '2 1 to S ;1 Current Property owner(s) 7c, g 1 14-&? k -e ci^ Day phone u Mailingaddress /47-70 S76,e R9 Lendingagency gm� Wettr FF4 n ftar tfi g- Day phone 7 V V Mailing address Real Estate Agent .5"xcw,, L7# c Le��^ <�z Dyoe4 m,e fozvy. Dayphone 'Z79 -7d// Mailing Address lil I "C" (00 9-9s'0-2 Unless otherwise requested, HAA will be held by DHHS for pickup. HAA picked up by: 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well EZ Individual On-site 19 Individual Water Storage El Individual Holding Tank El Community Class Well El Community On-site El Public Water System 0 Public Sewer El The Municipality of Anchorage Department of Health and Human Services (DHHS) 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. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties served by a single family on-site wastewater disposal andlor water supply system. DHHS also issues HAAs upon request to home owners. 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 less than 30 days old. 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. -2 C25 4 Ae� 01 001' 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my sea] 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 the Health Authority Approval application show 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 applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Ftcr AAp,-,, 7-ecAn;ml S�cl. Phone 71ys-- Address llf_5'�el 4, rl. h�e4e"-f;Rt. A -4c Engineer's Printed Name ' -7;4o,- cAov Plcc�,V Date j',4 (V '30 Z001-3 1 - 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments ENGINEER's STAMP ............... . .. bedrooms, with the following stipulations. Attachments: I HAA Checklist Maintenance Agreements Septic System Advisory Supplemental Engineer's Report Well Flow Advisory Other By: Original Certificate Date: -�2 LI -co Expiration Date: // - 2 1� - 0 C Reissue Date: 72 0.5 , Rev 01 00)' L CEIVtu Municipality of Anchorage Department of Health and Human ServIces . AUG 0 1 Division of Environmental Services On -Site Services Section 825 4L" Street Room 502 MUN40PALITY C� P.O. Box 196650 Anchorage, AK 99519-6650 r""' www.ci.anchomge.ak-us (907) 343-47" HEALTHAUTHORITYAPPROVAL CHECKLIST Legal Description: L -v t % 9 loc 14- 2 Ph -- de f le, c,-- g4afofp Ot I Parcel I.D.: e&a _-a9 z e. A. WELL DATA Well type Fv t Date completed !f 16 It A, B, or C provide PWSID # Sanitary seat Y Totaldepth ZZC1 it Casedto '27-c, ft FROM WELL LOG Date of test S/03 Static water level lli7 it Well production T* 9 -p -M WATER SAMPLE RESULTS: Collform __O —colonies/1 00 ml Nitrate 40-S- mg/I Date of sample: '71golaa— Collected by: BIA�IOLDING TANK DATA Tank TypelMaterial 5fee t Date installed 19 03 Tanksize 10cov gal Well Log Y Wires properly protected Y Casing height (above ground) I Y in. AT INSPECTION -r/ zo / 4,0 I Z. 5- it e. 3r -f g.p.m Other bacteria coloniestl 00 ml —wo--me %Mf4� Number of Compartments 'Z Cleanouts Y Foundation cleanourt Y Depression over tank N High water alarm P.A. Date of pumping -7f -49 / 00 C. ABSORPTION FIELD DATA Pumper Wo, r /A hzAd Pt=* 7 Date installed I o, 81 ?a Soil rating (g.p.d./M or ft2thdrm) 375' Sy stem type ffey( Length -YS- it Width 20-3& it Gravel below pipe Total depftq- i -Mit Effective absorption areal 12$112 Monitoring tube__!-- Depression over field- A/ Date of adequacy test _7LIv/ov Resufts(Pass/Fall) Pwu For 3 bedrooms Fluid depth in absorption field before test 0 in Water added_?Y9 gal. New depth_YL-_rg-1n. Elapsed Time: 1 '7 3 min Final fluid depth 011- in Absorptionrate >. 015'ep g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N &type) Monc ivw*~� If yes, give date ti -4. 72-026 (P�. 01=)' D. UFT STATION Date installed LgLLol4po Size in gallons __Swcj "Pump on" level at 37.5- in "Pump otr level at 3 1 in Datum- Oa/4^ oi(- ww*-f,4 Cycles tested --12--_ E. SEPARATION DISTANCES Manhole/Access �r High water alarm level at 'Y 3 in Meets alarm & circuit requirements SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot ?IV. On adjacent lots Absorption field on lot lqq On' adjacent lots fcAo Public sewer main A. Public sewer manhole/cleanout A/. 4. Sewer /septic service line -Ls, Holding tank SEPARATION DISTANCES FROWA�IOLDING TANK ON LOT TO: Building foundation Property line 701 Absorption field -Z 2 Water main > fe, Water service line > Vol Surface water Drainage la-cll Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line waqvv�r- IV ra-V r� . Building foundation ?j(" Water main S�o Water Service line V > sw, Surface water > 4r r-& I Driveway, parkingivehicle storage ix' Curtain drain A/P"e see^ Wells on adjacent lots _;* t4,,o, - F. COMMENTS G. ENGINEER'S CERTIFICATION JY, -1 N I certify that I have determined through field inspections and review of Municipal records that the above systems are in 1! .................. EWVER'S conformance with MOA HAA guidelines in effect on this date. I Engineer's Printed Name 7"J�4od;f0ee c= 1100'e . Tti— F. Aloope P Date 70 2000 ........ HAA Fee $ 9 oc? -�� Date of Payment ReceiptNumber 72 026 (%V. 01,100)' Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section . P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 0'Zo - 09 e - K?,\, HAA# 6�0452(Q24Q 1. GENERAL INFORMATION Complete legal description Location (site address or directions) I,< 7 70 S/C>A-- Rlr�� Ro�c< Property own�r 135,4'fel i J-0-yee CrOrle!� e Day phone '6 Mailing address I X 7 7 0 S)(�A e 4^cAore #' '4k 91S-4!:� Lendingagency Pcc- NW 7tife Xrv. 6c�. Dayphone SWI-S-IZZ Mailing address 3201 C " 5/.. -p;t 1 (0 . A^CA0f7,o Ak 9-9,5 40-7 Agent Jo -e Sre4er- f?e hiox f!S4.e--,',tr —.Dayphone Address -2600 Ccre;loc'ek V. Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPIE.OF WATER SUPPLY: Individual well Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-MIS".1/91) F�t MOAN21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verity that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system Is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and Inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. NameofFirrn rIOLA�,,!!! 7—,-cAn;er,( TL-er 7 '91 — 1-7 Phone Address I-IS30 5e46 S1 /4,1 r- A 0 /-er * e Ak- 99r1t( Engineers signature WZ� Date 6. DHHS SIGNATURE —9— Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 0 ILITIr. . . . . . . . . . . . . bedrooms, with the following stipulations: Date 8_31_�a The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given In paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions In order to satisfy certain federal and state requirements. Employees of DHHS do not conduct Inspections or analyze data before a certificate is Issued. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 72-MoWv.1.11) B� MOAN21 AUG 3 1 1998 Municipality of Anchorage "AICIPALITY OF VICE$ D DEPARTMENT OF HEALTH & HUMAN SERVICM,4y-�r'� Environmental Services Division 825 L Street, Room 502 e Anchorage, Alaska 99501 9 (907) 343-4744 'Health Authority Approval Checklist Legal Description: S/ k 2 Pa r -k P/,* ce 41 Parcel I.D.: 0 20- 09 Z - d? - A. WELL DATA wall type P64, it A. B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y — Date completed 4� /,Q 3 Total depth ZZ0, — C;asedto ?'20' Casing height (above ground) /'I " Sanitary seal (Y/N) Y FROM WELL LOG Wires property protected (Y/N) Y AT INSPECTION Date of test d163 R/ Static water level Well production g -p -m- g -p -m - WATER SAMPLE RESULTS: Collform 0 Ca I /10`0 Nitrate .4 0. 1 !! 11P-9) ,)t /-e Other bacteria )i av�e Dat9ofsample: 811Y19.9 612-c-119<9 Collectedby: B. SEPTIrdHOLDING TANK DATA Date installed 19493 Tank size t 000 r� Number of Compartments Z Cleanouts (Y/N) 'r* 7— Foundation cleanout (Y/N) Depression (Y/N) JV High water alarm (Y/N) jyl Al. Dateo!Pumping 01-711.9if Pumper 1>00,1-0/; 0 C. ABSORP'nON FIELD DATA . Cy, Date installed to/90 Soil rating (g.p.dJft2 or ft2tbdrm) __3 7Y-,!:!.- System type e g.,( Length 'JIS" Width To' -30' Gravel thickness below pipe 04" Total depth ?"t. 75" EffecWeabsorpdonama /12-'r 0' Monitoring Tube present (Y/N)-.!�— Depression over field (YIN) -1'-0 DateofadequaWtest 611'119B Results (Pass/Fall) ?Qc r For drooms 2. cf 2-r S Fluid depth In absorption field before test (in.); 0 immediately after��7gal. water added (in.): 2-Y H I ..r " -S Fluid depth 1q -S " At (ins) Minutes later,_j 74!� Absorption rate = > 'Y325 g.p.d. Peroxidetreatment (past 12 months) (Y/N) 1V*Ae k01�W^-Ify63,gtV8dat8 N. A. 72-026 (Rev. "6)' 0. LIFT STATION Date installed 10 / 17/ 9V Size in gallons 3Z.70 F a / Manhole/Access (Y/N) Y OPump on" level at* 39" *pump otr level at* High water alarm level at* 1134 — Datum ojclanAl- Cyclastested -> (49 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot Absorption field on lot 12,Y, I'Y'V I On adjacent lots > tco, On adjacerd lots > 100 - Public sewer main ri - A. —Public sewer manhole/cleanout IJ -A Sewer /septic service line > Z5- 1 Lift station I to * SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5 Property line 30, Absorption field 2 -2 # Water mairdservice line >,Yo' Surface water/drainage > I e -w ' Wells on adjacent lots > 100 ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 5 Z - (�= J Building foundation 36. Water mairdservice line '>S'O' Surface water -> 100' Driveway, parlding/vehicle storage area I -r I Curtaindrain IV*^e -ce A" - Wells on adjacent lots -> /CJO , F. ENGINEER'S CERTIFICATION I certW ftt I have determined thru field inspections and review of Municipal records Met The abvw sysWins am in conhormance wiM MOA HAA guidelines in effect on this date Signature T,-X&-ee� --x ?P;� ........... 'V-41 �41- Engineer's Name _rA fe oeoer_ "eo -e- il ......... Data .41/ - TL HAA Fee S 300 �� Date of Payment �Khvl,79� - Receipt Number z191 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE A&L DEPARTMENT OF HEALTH & HUMAN SERVICES - ALMA Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 3434744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# HAA# h\E\cVnQ19K-- 1. GENERAL INFORMATION Complete legal description Let- 'f, 13 Lc �-- 9 pet �te P/'Tq� S/o - A�ecll) ';tt I Location (site address or directions) 16730 S7t> A e 9 Lie R�' Property owner SLAL42 I-E6COAZC Dayphone '279 Mallingaddress XO -'7* 641. LIP( h�Y7 A�C40�?el A -k �)S`0/ Lending agency Day phone Mailing address Agent c4erse "ckrrtv^ t4,ritze 13ral gry6le Dayphone 'Z73-7'700 +A Ch &V� I+k 919-ro-I Address q 2 'If I? S4 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 ul-I NOTE: If community well system, provide written confirmation from StatoAoEC attest - Ing to the legality and status of system.' 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-Mjaw.1/91) Frwl MOA621 5. STATEMENT OF INSPECTION BY ENGINEER Ascertified bymysealaffixed heretoanclasof the validation date Shown below, Iverifythatmy investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection. the on-site water supply and/or wastewater disposal system Is in compliance with all Municipal and State codes, ordinances. and regulations In effect on the date of this inspection. Name of Fi rm fl- (c, LL4 TecA n 1-cA, Se '-" 1 c fJ — Phone -3 13�6 Address I'VS-?O 454A" V., A^C_AOLC�4 44— 9 fs 16, Engineer's signature Date /Ng W/- Z-8 19 ge 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (bHHS) issues Health Authority Approval Certificates based only upon the representations given In.paragraph 5 above by an independent professional engineer registered in theStateof Alaska.The DHHS does this as a courtesy to purchasersof homes and theirlencling institutions In order to Satisfy certain federal and state requirements. Employeesof DHHSdo not conduct Inspections or analyze data before a certificate is issued. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 72-025M..IAI) SWX MOA621 h"IUPAUTY OF AWHOkAGe ENvZCg4VjfWAL SWAM VIVISM MunIcIpality of,Anchomge SEP 03 1996 DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825-V Street, Room 602 9 Anchorage, AlasM 995019 (907) .43-4UCEIVEDE Health Authority Approval Checklist LzZaDescription: I-* � 'f. Clock? Pgrk Plotce #/Parcel I.D.: 0 20 -09',r -dZ -OCO-9 Y A. WELL DATA Well type Pre - v a k If A, 13� or C. attach ADEC letter. ADEC water 09cm number Log prment (Y" Daft completed 9 / 2 2 / 0 3 Total depth P20' —Casedto ?20' Casing height (above pound) sanitary sw (YIN) Win* properly protected (Y/M r FROM WELL LOO Date of test Static water level Well production WATER SAMILE RESULTS: AT INSPECTION a/ I-?- t 9e 1Z. �r 9 -p -M. �-. 2 * 9 -P.M. CDlif0rM Ofgf./fOOdWt Nit= 1, C. (1!�j 14 OLherbactma N60f frpo- W Datoofample: Collected by: rlol-lve -reC4 Svc & SEFnC410LD1XG TANK DATA Date installed 1903 Tank aim f 00o;fa( Number of Compartmains *e Ckanouts (Y"_L__ Foundation cleanout (Y/N) r Depression (YIN) N msh w= alum (YIN) a 4. Damorpumping 81917ir Pumper �Cgar�cf C. ABSORMON FEW DATA DaMinstalloti 10170 Sod rating (gp.dearWrodrin) 37.f'O' Systcmefix Cc,( 04(r. 3yft--0�45:L Length __t,!�_Wlilth ?a' -30' Gravel thicitnessbelow pipe 0.5" Total depth 2 '- Y. -PS" Effective absorption area 112570' Monitoring Tube pr=nt(Y"__)L Depression over field (Y/N) 11 Date of adequacy test 8 / 2 2 / 94f Results (Pas0a) PDXf For 3 bedrooms Fluid depth in absorption &W bdbm ten (m.); 49 Immediately after= gal. water melded (in.): 0 Fluid depth __Q_(int) Mutes law__r _ Absorption raw - -'>��p d. Permdft treatment (past 12 months) (Y/N) Voaa Wgwwn lryesgived= W. A. D. UFT STATION Date qnstalled 10/1-? /70 size in galkins 5-00 Manhole/Accew (Y" Y, "Pump on" level so 3,7 " -pump afr level at* 2 2 High water ahum level at* ik j 3 -*Datum 8vHv" of vouff Cycles tMed --, 8 I. SEPARATION DISTANCES SEPARA77ON DISTANCES FROM WELL ON LOT TO: SepticUlding tank on lot /Zv' -;On adjaccat lots -> f v q Absoqition field on [at 11 61' _;On adjacent lou I> I or, Public sewer main Public sewer manholdc1canout M A Sewer h;cpdc service line LAft Station -- 1 %9, S13PARAMON DISTANCES FROMsErnaHoLDiNG TANK ON LA)T To Building foundation S., Property line 20, Absorption field 22' Water mainizervice Ime > to urface wateddrainge > (yo' Wells on adjacent lots > 100' SEPARATION DISTANCE FROM AllsowynON FIaD ON LADT Tor Building foundation Id, Property Line S" * Water maintservice Ime i a )6 tvarovii, Itrud-o( W11,196, Surfacewater > too' Driveway. parbtiglvchicle amp area iol Curtaindrain Mone �&vA Wellson adjacent lots '> too' F. ENGINEER'S CERTIMATION I certify dua I have determined drufteld inspections and review ofAirmicipal reca�r4a - in conformance with MOA MAA guidelines in effect on this date T X Signature ........ Engineer, ; BM s Name evg&re =1-..Z r -7 Daft Aj�e6ak 30 /99 1� HAA Fee S -7 00 Dam of payment. Receipt Number 7- 7- / z (Z- Rev. W95 OSS: haawiLdoc Weiver Fee S Date of payment Receipt Number P -3 d MUNICIPALITY OF ANCHORAG DEPARTMENT OF HEALTH & HUMA14ESERVICES 16alh Division of Environmental Services low On -Site Services Section EX -1 -El P.O. Box 196650 Anchorage. Alaska 99519-6650 3434744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D.# HAA# OQ00-101010 GENERAL INFORMATION Complete legal description IoT 40 7ARK PtACF- Dr)'H Location (site address or directions) IL -730 STONE RID6C Rb- ANCOORA6F Ak Property owner _�kv,5614 I A 6ut4tr- Dayphone :272-q741 Mailing address 25-.5.0 I)pn'� G, V, .1 An r -A c' C7- e.0 +k 99SV3 Lending agency 5FATIL-C _MoRT6A6E Dayphone XKz-z"eP—K Mailing address xe'o 9 03 Y �' A-vt._ A�cherqg, Me _?9S -0:r Agent N. 4. R e 4;, ey P, C 0-) Day phone I Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: if community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: individual on-site Holding tank Community on-site Public sewer NOTE: if community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72425(Rw-1121) FWMI MOAR21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seat affixed hereto and as of the validation date shown below, lverlfythatmy 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 I urtherverify that based on the information obtained from the Municipality of Anchorage files and from my invest!gation 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 ELATTOP -TECH SVCS Phone ZL4S- 13-T.T- Address IL4530 r-CHo ST�, Aiica. AK J!95-16 Engineer's signature Tj=� —Date CCAf. 1993 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. n�ms(p�-,Al) Back MOA621 A' 1 1*6 * ' .. 1 1. TII pegs. 4.0100.0. 0.10000'..60 .............. 1.06:0.0 A IV, P . THEODORE 1'. M RE CE -3589 60" ... 4-- 6. DHHS SIGNATURE Approved for r6L1?1AEE-(3_ bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: 4�� — Date /0-10-93 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. n�ms(p�-,Al) Back MOA621 Municipality of Anchorage AL Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: I oT 4. 13L.K -2 PA�K F4ACC —Parcel I.D. 2- A. Well Data Welltype PRIVATE If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y —Date completed (o 18-3 -Driller -VERN'.5 DRILLA46 0cct1100^-e_ Total depth 220 Cased to 22o I —Casing height 14 :5rcs Sanitary seal (Y/N) Wires properly protected (YIN) FROM WELL LOG AT INSPECTION C) 0 Date of test Static water level 0 Well flow —9 -p -m- —g -p -m- rn C Pump levell SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 12 q' On adjacent lots 00 Absorption field on lot On adjacent lots 7 /00 Public sewer main N.A. —Public sewer manhole/cleanout Sewer service line 1101 Petroleurntank N014C 013 -SERVED WATER SAMPLE RESULTS: Coliform 0C0(1'c'o^,e Nitrate 4 0-1571x Otherbacteria 0cct1100^-e_ Date of sample: 911-7/93 Collectedby: FL,4TTOP 7FCO :5rcs B. SEPTIC/HOLDING TANK DATA Date installed 19S.3 _-Jank size 1000 —Compartments 2 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression (Y/N) N High water alarm (Y/N) N.A- Alarm tested (Y/N) N,A. Date of pumping F/ F-S"I Pumper =:f Inc _r SEPARATION DISTANCES FROM SEPTICAIOLDING TANK TO: Well(s) on lot 12 4' -0nadjacentlots; -71000 —Foundation Topropertyline ?0' Absorption field 22' -Water main/service line > 40 Surface water/drainage > 100' 72-026 (3t93)* Fwt CONTINUED ON BACK PAGE C. LIFT STATION Date Installed lo 111190 -Manufacturer A N CHORA( E -IA?W / OREN co Size In gallons 5C)o Manhole/Access (Y/N) Y Vent (Y/N) nPumpon"Ievelat 39" -.Pump off Level at 311$ High water alarm level Y3 It —Cycles tested -7 Meets MOA electrical codes (Y/N) NO VIOLATIONS ORSEOPVED SEPARATION DISTANCE FROM LIFT STATION TO: Wellonlot '-�-Iqo' Onadjacentlots; >10o' -Surface water `7 100 D. ABSORPTION FIELD DATA '37S' F&60tm Dateinstalled lo/10 Soil rating (GPD/Ft) 0. If -Systemtype FED Length 145' Width 20' _-�O' -Gravel thickness -0. 5 Totaldepth 2'-14.7S' Total absorption area 112.T R2 Cleanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 9 b-1/93 —Results (pass/fail) PASS for 3 Bedrooms Water level In absorption field before test 0 After test Peroxide treatment (past 12 months) (Y/N) NONE �rNDVN If yes, give date N -A - SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 14'4' On adjacent lots > /00' —Property line 8 Ot4 'rap OF FORPON To building foundation I& To existing or abandoned system on lot OPABANDONCD) SYSTCM On adjacent lots > 4 0' -Cutbank N,A. — Water main/service line Surface water > too' Driveway, parkingivehicle storage area 15' Curtain drain N'JNE QS SeRVE0 E. ENGINEER'S CERTIFICATION I certify that I have checked, vefifiect or confinTned to all MOA and HAA guidelines in effect on the date of this inspection. 'Tl_'�� -�r 'OF . Signature 49TII Engineees Name -Meyaorr- 10. Date 0 C' f, 1 /9.) r j4 THEODORE F. AACORE ? E-3589 C HAA Fee $ Date of Payment /0 _/_" Receipt Number 72-026 (3t93)* Back Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRCNMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Infcrmation Application Date (a) Legal Description (include lot, block, subdivision, section, township# range) Lot 4 Block 2 Park Place Subdivision #1 Location (address or directions) .345-b828 (b) Applicants Narm William R. Strickler Telephone 2GG-1547 Applicarts Address Star Route A Box 474-K Anchorage 99507 (c) Applicant is (check ore) Lending Institution owner/builder Buyer [� ; other f� (explain); (d) Lendirg Institution �Iomc Savings and Loan Telephone 563-4663 Address 535 D Street, Anchorage, Alaska 99501 (e) Real Estate Co. & Agent. The Real �_state Company, Paul Palmer Addres - s 411 East 36th Avenue, Anchorage, Alaska 99503 Telephone 276-1902/344-4276 2. Type of Pesidence Single -Family 10 Number of Bedr0c= 3. Water SUPPlY Multi -Family f:::l three Other (describe) individual Well = C=wnity [::� Public �_j Note: if camunity uell system, nust have written confirmation frcm the State Departrent of Envirorzental Conservation attesting to the legality and status. Is the well adequate for the r=ber of bedrooms specified in this HAA (YIN) 4. Sewage Disposal Onsite C]R Public r:=l Camunity f=j Holding Tark r::l Is the wastewater disposal system adequate fcr the rLmter of bedrooms (YIN) - [Page 1 of 21 2-15-84 5. Engineering Firm Providing Inspections, Tests, D3ta and Information I certify that I have checked, verified, or confczi, d to all mm HAA Guidelines in effect on the date of this inspection. Signed — Date Nam of Firm Bush Engineering Telephone Address THE ORIGINAL IS ON FILE WITH Signed by THIS DEPARTMENT AND THIS IS FOR A FULL APPROVAL. IF THERE Date ARE ILNY QUESTIONS, PLEASE CALL THIS OFFICE FOR VERIFICATION 264-4720. (ENGINEER SEALY .6.DHEP Approval Approved for b--drooms Approved rz� Disapprowd r—_1 Terms of Conditional Approval a Conditional r—_1 Date 9/ �fv The Municipality of Anchorage Department of Health and Envirorinental Protection does not guarantee the continued satisfactory perfcrmanoe of the water supply and/cr t1-0 wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and infcrmation furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func-- ticnal for the rmmber of bedrocos and type of st=ucture indicated. (DHEP SEAL) 7. Mail th-- HAA to the following address: KB2/d5/s (Page 2 of 21 2-15-84 MUNICIPALITY OF PJNCHORAGE DIVISION OF ENVIROMMENTAL HEALTH DEPARIMENT OF HEALTH AND ENVIRONMENTAL PROIECTION APPLICATICN FOR HEALTH AUI111ORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) legal Description (include loto block, subdivisionp secticnr tcwnshipt range) L,ocation (address or directions) (b) Applicants Narm. VAI 5W Z - /'r:1 'e- z;o "C �Vz�) Applicants Address 9r'9_ -e)7 owner/builder (c) Applicant is (check one) Lending Institution Buyer [:=[ ; other f=j (explain); (d) LendirQ'Instituticn _5�q,�-IWX6 9'_ZQXk1 Telephone Address .535- 1) (e) Real Estate Co. & Agent 10�.41-A-7nrc- LO. 0 PA1,4 Address Telephone 27&-1,707 /_-?4jq-477�377 2. Type of nesiderce Single -Family M Number of Uedrocms 3. W3ter Supply Multi -Family f_:j 3 other (describe Individual Vbll Camunity Public Note: If camunity %,ell system, must have written confirmaticn from the State Wpartnent cf Envirormental Conservation attesting to the legality and status. is the well adequate for the number of bedroam specified in this HAA (YIN) 4. Sewage Disposal Orsite M Public �_j Cwnunity �:� Holding Tank [-::I is the wastewater disposal system adequate for the number of bLdrocms (YIN) (Page 1 of 21 2-15-84 r�) 1110�� 5. En ine6ring Firm Providing Inspectionsr lbsts, Data and Information I certify that I have checked, verified, or confan d to all MDA RAA Widelims effect on the date of this inspectibn. Date Signed ?/491/h 47eOO' Nam of Firm 'Vq 1�'t/c t. J'- r Address P rX -,Y— Signed by Date C)F A co gr m 0' RAI IQ �LgWeq' p,berf D. Bush JU -4� Al (ENGINEER SEAL) CE -5333 !,�O�zy 6.DHEP Approval cm te Approved for tedrooms Approw-d Disapproved f=j Conditional tt'Zt V -1Z I/x Terms of Conditional 7he Municipality of Archcrage Department of tbalth and EnvircrTental Protection dces not guarantee the continued satisfactory performance of the water supply and/= the wastewater disposal system. This approval indicates that, as of the validation date shown abovep based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the rimiber of bedrocms and type of structure indicated. (DHEP SFAL) 7. Mail the HAA to the following address: (7 L I '� AC, -c M2/d5/s [Page 2 of 21 2-15-84 Wh e4) MUNICIPALITY OF ANMRAGE (MOA) HEAM AUTHORITY APPROVAL (HAA) CHECKLISr - FEBRUARY 1984 Legal A. WEIL DATA MLINfCIPALITY OF ANC14ORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTEa" MAY 18 1984 n r AFL-rGEI M z - Wall classification TAjd: y,-elnx, L If At B, Or Cr D.E.C- ARXoved(Y1V) kf /W - wall Log present (y/N) V0_5 Date Completed (0/S3 Yield 5-6?A + Total Depth !�72 0 f 11 Cased to 220 Depth of Grouting —0 Static Water Level 40 , — Pump Set At 2 PC) it Casing Height Above Ground /R // Sanitary Seal an Casing (18N�qp Electrical Wiring in Conduit (YIN) YeS ___ Depression Around Wellhead (YIN) IF separation Distances from Wallo To Septic/Holding Tank on Lot /'d7- on Adjoining Lots __ _.1,970 -F74 + To Nearest Edge of Absorption Field on Lot f On Adjoining Lots /5Q � / To Nearest Public Sewer Line AJ 104- To Nearest Public Sewer 4111� cleancut/Manhole AJ 1A To Nearest Sewer Service Line on Lot IVI,4? Water Sample Collected By 14*�fr"Clrley- Da Water Sample Test Results '4�0 -/i 5 fcc �ov $4 r7llAlhq r�nt-a 74/ /?Ic &P �R / k ALs 4 V B. SEPTIC/HO ThNK DATA WINI3 Date installed Size /Orj,5 �p,41 - No. of Compartments 7(AJ t) Standpipes (y/N) Air -tight Caps (YIN)Illec, Foundation Clearx)ut (Y/N-LVo.C1 /V/ f Depression over Tank (y/N) Ajo __ Date Last Pumped il"Ve-V S4.c�eft) aurpiTIg/Maintenance Contract on File (Y/N) AJQ for -/V Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Pervdt tylA Separation Distances from Septic/Holding Tank: To 1�bter-SupplY W311 11,5- 6/- To Building Foundation 14 To Property Line To Disposal Field ic 211 - To Water MairVService Line /U-/,#- To Stream, Pond, Lake, cr'Major Drainage (Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Jr - Soils Rating in Absorption Strata Type of System Design Se -4 Date Installed Length of Field __,3Z Width of Field 2-1-- Depth of Field 15" 65:: Gravel Fied Thickness —_57, g-ye�� 7�r- Square Feet of Absorption Area 4kO C7� A�f Standpipes Present (YIN) Depression over Field (Y/N) A/go Date of last Adequacy Test Results of Last Adequacy Test Separation Distance from Absorption Field: To Mter-Supply %bll / zs- / To Property Line �4- To Building Foundation If ft- To Existing or Abandoned System on Lot On Adjoining Lots t7' 9.!� -,C74- To Water Mairv�Service Line Aj,�� To Cutbank(if presert) To StreamA)crAAake/cr major Drainage Course 1,2c To Drivewayp Parking Area, or Vehicle Storage Area pwx-"Is�r r7 � -r�L Z. - -r- -- . / e) A". -.t e) C/ 7* 7rral),, /V -OW _ VeCA RC,00�1 D. LIFT STATION Date Installed Dimensions X 7C71 Size in Gallons tzar, a4z Manhole/Access (YJw) ke "Pump On" Level at /. �' Off" Level at 9 "" c bo�e-- go z%,t, High Water Alarm Level Vent (Y/N) )�es Tested for Pumping Cycles during Adequacy Test. Masts MDA Electrical @SWY/N) Ve-s 17U -MVINfid rg Check Permitted Bedr-oan Rating Agairzt HAA Request I certify that I have checked, verified, or confcrmd to all HA%�"Q off ect m ir on the date of this i ction Signed &i L-/ �7 __Pate !;2�w % -0 0 Caqpany �10A No. --T3 . u* -. * 6 *so - K31/d5/s *too too 0:0* , X Robert D. Bus 0 %...E- 33. . 5t� AV (Page 2 of 21 2-15-84