HomeMy WebLinkAboutKIMBERLY MANOR #2 BLK 3 LT 11  Municipality of Anchorage Department of Health and Human Services Building Safety DMslon On-Site Water and Wastewater Program, 4700 South Bragaw Street ~ .~ P.O. Box 196650 An(hot'age, AK 99519-6650 Page of www.cl.an(horage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWSW040105 PID Number: 017-073-45 (1.~rnld & R~rh~r~ Hnrv~_v Wastewater System: I-1 New ~ Upgrade Rdt~l Rnhhlt Cr~_~_k Rd__ Anch. Al( g-q516 ABSORPTION FIELD 345-8771 4 ~C,.pT,'.,.* OS~,.T~.~ e~ c~,~ oo~,~ LEGAL DESCRIPTION s~..,.~: 0.4 ~.o~e 3.5 to 4.5 '1~ '~ ~ J J Klmberlv Manor 3 to 4 n, 0,5 ~, 0 'I, 73 Well: I--I New [] Upgrade ~''d~'~0 tO 17 "~"~""': I ,,, 5 3 to 5 Existg Private ~,. ,, 2084,61 ~e '~C~zC'PV ~. o.,. .,. TANK SEPARATION DISTANCES D septic r-I Ho/ding D S.T.E.P. I-I Other:. TF~,~ Sep§c AbsorpUon Lift Holding )ub~ic/PdvateIv~ur~: Tank Field Station Tank Se*e~[~ EXISTING CONCRETE ~. w.. 144 125 90+ u.,.~: s~..w.,,. 100+ 100+ ~/ LIFT STATION ~.. 30+ 0* ~/ n'": ~"~: ° R~quest Lot Line WalYer to 0 [eet to malntaln ~ ~' BENCH MARK · eparatlon to slope greater than ~$%. ~'~% to~- Patio Door Threshold ~--t~.c,d~.t~'i~. X.~ttt.,s3o'~' iA~,~-r--~'~w~,~.~.~,c, 100.0 Ft. Inspections peffo~ed by: Pannone Ena. Svc Dates: I 5/12/2004 = ~ ~ -- ~ Depa~ment of Health and Human 8e~ie~s ~roval _ . ~m .~e~ .. ~o~o~.~.'~'~ ' ' -' ." ' ..... ZT,;,~* PERMIT NO! SW040105 P.I.D. ND: 017-073-45 / I LOT 11, BLOCK 3 KIMBERLY MANOR RECORD DRAWING WASTEWATER DISPOSAL SYSTEM fl2 S/D x I 1985 SOILS TEST & PERC TEST. E~'ST'O WELL EXIST'G WELL NOTES: I) All wo in 1;o AMC 15.65. oved existing droin rock ,Situ- soil ~contomino t ed ! EXIST' DDU; /'CLEAN-OUT~. AFTER TANK NO WELLS DR SEPTICS W/IN 100 DF SEPTIC SYSTEM 'p,"oper' new bed in ~e~ o~ndoned bed. MONITOR .E DRY 5-1', O'wxO.5 5O; SWING TIES CD A B TI 39.5 32.1 T2 47.3 41.4 Cl 19.6 31.2 C2 14.4 20.1 C3 16.3 16.3 C4 19.8 13.6 C5 30.5 23.2 C6 46.7 43.4 C7 77.2 77.9 HI 24.0 15.6 N~ 19.4 30.~ M3 79.9 Bl.I PREPARED FOR: Gory &Borb Horvey BO01Robbit Creek Rood Ancho?oge, AK 99516 345-8771 345-3707° Ex~ 5 DESIGN: PERC RATE, 16.7 MPI APPLICATION RATE, 0.4 GPD/SF 4 BR HOUSE REO'D AREA: 1500 SF ACTUAL AREA 208~.61 0.5 EFFT'V DEPTH PANNDNE ENG. SVC, LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218 P, 272-8218 Fox DATE, 5-19-04 J RECORD DWG SCAL~': 1'=60' PER. T NO: SV040,05 DETAILS WASTEVATER ABSORPTION SYSTEM LOT 11, BLOCK 3 KIMDERLY MANOR #2 S/D I) ALLVORK PERFORMED IN ACCORDANCE WITH. & ALL METERIALS CONFORM TO AMCI~.G~. 2) ADDED 2' OF R.I. OVER ENTIRE BED. 2) MAINTAINED ~0' SEPARATION ?ROM ALL SLOPES GREATER THAN 25%. z~ ~3~0 P.I.D. NO: 017-073-45 Z r-t m.m :%Vor'k\11-3 KIMB;'RLY MANOR.D~,/G L~lO NV313 PREPARED FOR: Gory &Borb Norvey 8001 Rabbi% Creek Rood Anchoroge, AK 99516 345-8771 345-3707o £x% 5 Ponnone Eng. Svc., LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 272-8218~ PHONE & FAX DATE~ 5-19-04 NOT TO SCALE DETAILS MUNICIPALITY OF ANCHORAGE Development Services Department On-Site Water & Wastewaler Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Renewal Date Issued: May 05, 2004 Expiration Date: May 05, 2005 Permit Number: SW040105 Legal Description: iKIMBERLY MANOR//2 BLK 3 LT 11, Design Engineer: 0062 Pannone Engineering Services Owner Name: GERALD G. & BARBARA E. HARVEY Owner Address: 8001 RABBIT CREEK ROAD ANCHORAGE, AK 99516- Parcel ID: 017-073-45 Site Address: 008001 RABBIT CREEK RD Lot Size: 68800 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: [] Disposal Field [] SepficTank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. Absorption bed must be moved so that a 10 feet separation to the house foundation is created Received By;. Issued By:. Date: Date: ,..~- ~'""" 0 ~' Mnnicipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/VVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. Permit Number SW rO/-{t-O 10.5' Property owner(s) Mailing address (1). Day phone Mailing address (2). Legaldescription(Lot, Slock&Sub'd.) I_ I~ Legal description (Section, Township & Range) Lot Size (0 c~'[ ~1~) (~') Acres(~. THIS APPLICATION IS FOR: Sewer Only Sewer and Well Sewer Upgrade Zip Code Number of Bedrooms [] Well Only []  Water Storage [] THIS PROPERTY CONTAINS: Hot Tub [] Jacuzzi [] Swimming Pool [] Water Softening Unit [] Therapy Pool [] I certify that the above information is correct. I further certify that this application is being made for a Singlff Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: ,~.~, ~.~/,~.~f ..¢"1 I~" Waiver Fees: Date of Payment: /--/-..~"- O ~ Date of Payment: Receipt Number: O ~ / ~ C) '~ ~ Receipt Number: (Rev. 12/00) h t tp://v,~xw, mtm I.org April 23, 2004 Gerald G 8: Barbara E Harvey $001 Rabbit Creek Road Anchorage, AK 99516 Subject: On-Site Water and/or Wastewater Permit. Permit Number: SW030115 Legal Description: Kimberly Manor #2 Block 3 Lot 11 Dear Mr. & Mrs. Harvey: An On-Site Water/Wastewater Permit, number SW030115, issued by this office for a single-family system, will expire on May 4, 2004 This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as-built inspection report must be sent to this office for review, approval and documentation. This as-built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As-built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. A new permit for a second year may be issued for a fee of $115.00 if the renewal application is received on or before the expiration date of the original permit. When applying for a new permit, the fees are: $460.00 for a wastewater permit and $175.00 for a well permit. If you have any questions, please call this office at 343-7904. Jame~Cr/oss, P.E. Manager On-Site Water and Wastewater Program Enc: Copy of permit MUNICIPALITY OF ANCHORAGE Development Sen/ices Department On-Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: May 05, 2003 Expiration Date: May 04, 2004 Permit Number: SW030115 Legal Description:i~(IMBERLY MANOR #t2 BLK 3 LT.11 Design Engineer:. 0062 Pannone Engineering Services Owner Name: GERALD G. & BARBARA E. HARVEY Owner Address: 8001 RABBIT CREEK ROAD ANCHORAGE, AK 99516- Parcel ID: 017-073-45 SiteAddress: 008001 RABBIT CREEK RD Lot Size: 68800 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of:. [] Disposal Field [] Septic Tank [] Holding Tank [] Privy [] Private Well [] Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to Apd115, a subsurface soil absorption system under construction dudng freezing weather must be either:. A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. ABSORPTION BED MUST BE MOVED SO THAT A 10 FEET SEPARATION TO THE HOUSE FOUNDATION IS CREATED. Received By: / ~.~ Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 017-073-45 Permit Number SW~ ~ O I I~'" Property owner(s) Ga~ & Barb Han~e¥ Mailing address (1) 8001 Rabbit Creek Road Day phone 345.3707, Ext 5 Mailing address (2) Anchoraf~e, AK Legal description (Lot, Block & Sub'd.) Legal description (Section, Township & Range) Lot Size ~ Acres/~J THIS APPLICATION IS FOR: Sewer Only [] Sewer and Well [] Sewer Upgrade [] THIS PROPERTY CONTAINS: Hot Tub [] Swimming Pool [] Therapy Pool [] Zip Code 99516 . Lot '11, Block 3 Klmberty Manor S/D, Add'n No. 2 Number of Bedrooms 4 Well Only [] Water Storage [] Jacuzzi [] Water Softening Unit [] I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and Is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit Fees: Date of Payment: Receipt Number: (Rev, 12/00) Waiver Fees: Date of Payment: Receipt Number: l°annone Engineering Services~ r. LC Consulting Engineers (907} 272-8218 P.O. Box 102954 Anchorage, Alaska, 99510 (907)272-8218 Fax April 27, 2003 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 S. Bragaw Street P. O. Box 19§6S0 Anchorage, Alaska 99S 19 Subject: Gentiemen: Lot 11, Block 3 Kimberly Manor S/D, Addn No. 2 Septic System Replacement Permit Request Failed Septic System - PLEASE RUSH My firm was asked to investigate a failed septic system serving this lot. The existin§bed was inundated with liquid when I arrived. The system is in failure.The system was upgraded in 1985. Documentation of the upgrade was not available at your department. TheOwner's fries contained documentation of the 198S upgrade. I am attaching to this application for your records.An undocumented trench was attached to the bed in the summer of 1994. S&S Engineers performed an investigation of this undocumented trench in October of 1994 as wells a soils investigation when the current Owners bought the property. I am also attaching their letter for your records. The attached trench was also found to be in failure. A soils investigation, percolation test and water monitoring was performed in 1985. My firm excavated a water monitoring test hole this spring. It is my intention to replace the existing bed with a new bed in the same location. This need to be done due to geographicalconstraints. The property is bounded on the north by the Old Rabbit Creek Road Right-of-Way. To the south is a steep slope The lot is triangular shape. The well is located in the western portion of the lot. Contaminated material under the existing bed will be removed and replaced with MOA Specified friter sand. An identical bed will be constructed in the same located of the failed bed. The lot is approximately74,034 square feet in size. Lot 11 slopes to the east at approximately 1 percent in the area of the proposed system. The existing septic tank will bereused. The proposed installation will be located on the western portion ofthe lot. The lot is served by a private well. The proposed location is greater than 100 feet away from existing & neighboring wells and 25 feet from the water service lines. The surrounding wells are located greater than 100 feet from the proposed installation. The proposed installation will not affect the future development of the surrounding or existinglots. See the attached Desig~ If you have any questions or concerns, please contact me at 22'~3522 or 272-8218. C:~Work~tters~ 11-3 Kim~rly Manor,001 ,doc Civil Engineer P£RHIT ND~ SV03 P.LI). ND, 017-073-45 NrlT£S~ In DESIGN DRAWING WASTEWATER DISPOSAL SYSTEM LOT 11, BLOCK 3 KIMBERLY MANOR #2 S/D E/XI'ST'G ~ WELL' "l E EXIST'G ! 1250 -~ ______-- AFTER TANK *o AHC exls*lnO d~ln Pock N~ WELLS DR SEPTICS ' W/IN tO0 DF SEPTIC SYSTEH 1985 SOILS TEST & PERC TEST. v~*lon *o proper o? MONITOR TEST 63LFx33'wxO,5 0% 50} new bed In d over PREPARED FOR, O~ry &Dorb Horvey 8001R~bblt Ceeek Anchoroge, AK 99516 345-B771 345-3707, Ex~ DESIGN, P£RC RAT£1 16.7 MPI APPLICATI~IN RAT£~ 0.4 GPD/SF 4 ~R HDUS£ REQ'D AREAl 1500 SF 0.5 EFFT'V ~PTH PANNONE ENG. SVC, LLC P. 0. BOX 102954 ANCHORAGE, ALASKA 99510 227-3522 P, 272-B21B Fc~x ~}ATE, 4-~$-03 j DESIGN ~CALF9 PERMIT Nnl S~/03 NDTES~ l) ALL~/nRK SHALL BE PERFORMED IN ACCDRgANCE ~/ITH, & ALL HETERZALS SHALL CONFORM Tn AMC[$.65. 2) AD9 A HININUN Df' 2' DF R.I. rtvER ENTIRE BEt% 3) HAINTAIN 30' SEPARATION FROM ALL SLOPES GREATER THAN 257. ])F'SIGN ])FTAILS ~/ASTE~/ATER ABSORPTIDN SYSTEM LDT 11, ]~LDCK P.I.D. ND, 017-073-45 Z W W P~nnone Eng. Svc,, LLC P. 0. BOX 102954 I ANCHORAGE, ALASKA 99510 J 272-B21B~ PHONE & FAX J DATE* 4-26-03 J J NOT TO SCALEJgESIGN J Parcel I.D. CERTIFICATE FOR A 34-70 1. GENERAL INFORMATION Municipality of AnchOrage DeVelopment Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 OF ON-SITE SYSTEHS SINGLE FAHILY APPROVAL DWELLING COSA# ©~C__. [ /\ 5g ~ Expiration Date: ~2~ _ / ._~'-'_/_.~.._ Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address KIMBERLY MANOR #2 BLOCK 5, LOT 11 8001 OLD RABBIT CREEK ROAD *ANCHORAGE, AK 99516 ROSE PAK Day phone 276-222.3 8001 OLD RABBIT CREEK ROAD *ANCHORAGE, AK 99516 Day phone JOHN BLAINE W/PRUDENTIAL Day phone 229-8050 3801 CENTERPOINT DRIVE #200 *ANCHORAGE, AK 99505 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well · Individual On-site · Individual Water Storage [] Individual Holding tank [] Community Class__Well [] Community Omsite [] Public' Water System [] Public Sewer [] The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water samples. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Municipality of Anchorage Development Services Department Building Safety Division On-Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak, us (907) 343-7904 CERTIFICATE OF ON-SITE Legal Description: KIMBERLY MANOR #2 BLOCK 3, LOT 11 WELL DATA *SEE ATTACHED AAROW PUMP AND WELL SERVICE REPORT SYSTEHS APPROVAL CHECKLIST Parcel ID: 017-073-4.5 Well type PRIVATE IfA, B, or C provide PWSID# N/A Date completed UNKNOWN Sanitary seal (Y/N) YES Total depth '130 ft. Cased to *63+ .ft. FROM WELL LOG NO WELL LOG ~ g.p.m. Well Log (Y/N) Wires properly protected (Y/N) Casing height (above ground) AT INSPECTION 12/1/2011 *87 ft. *7.2 g.p.m. Date of test Static water level Well production WATER SAMPLE RESULTS: Coliform 0 colonies/100 mi. Arsenic: ND ug./L. NO YES · 12+ in. N/A Soil rating (g.p.d./f¢or~ 0.4. Width 4-0 TO 17 .ft. Total depth 5-5 ft. Eft. absorption area2084.61ft2 Monitoring tube YES Date of adequacy test 11/21/11 Results (Pass/Fail) PASS Fluid depth in absorption field before test 0 in. Water added 1022gal. Elapsed Time: 124. min. Final fluid depth 0 in. Any rejuvenation treatment (past 12 mo.) (YIN & type) System type BED Gravel below pipe .5 ft. Depression over field NO For 4. bedrooms New depth 0 in. Absorption rate >-- 600+ g.p.d. NONE KNOWN If yes, give date - Foundation cleanout (Y/N) *YES Date of pumping 11/1 ¢;/11 ABSORPTION FIELD DATA Date installed 5/12/2004. Length 73 .ft. Tank Type/Material CONCRETE Date installed Tank size 1250 gal. Number Of Compartments 2 Cleanouts (Y/N) Depression over tank (Y/N) NO High water alarm (Y/N) Pumper. ISAAC'S PUMPING 7/16/1985 YES Nitrate ND mgJL Collected by: AAROW PUMP & WELL Date of sample: 11/29/2011 *CONFIRMED FOUNDATION CLEANOUT. IN THE CRAWL SPACE. SEPTIC/HOLDING TANK DATA SEPTIC TANK INFORMATION PER 2004. COSA BY STEVE PANNONE, P.E. D. LIFT STATION E= Date installed "Pump on" level at in. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Size in gallons Manhole/Access ~/~N) j "Pump off" leve~ High water alarm level at Cycles tested Meets alarm & circuit requirements? Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A Sewer/septic service line 25% Animal containment areas 50' + in. On adjacent lots. 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout Holding tank N/A Manure/animal excrete storage areas N/A 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field Water main N/A Water service line 10'+ .Surface water. Wells on adjacent lots 100'+ . 5'+ 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line *0 Building foundation 10'+ Water service line 10'+ Surface water 100'+ Curtain drain NONE KNOWN Wells on adjacent lots. 100'+ F. COMMENTS ADDITIONAL COVER TO Water main. N/A Driveway, parking/vehicle storage 10'+ *WR#040032. THERE IS ONLY 18" OF SOIL COVER OVER THE SEPTIC TANK. BE PLACED IN THE SPRING OF 2012.' DRAINFIELD IS LOCATED 25' FROM CUTBANK. G. ENGINEER'S CERTIFICATION I certify that I have determined throUgh field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date. / z. /3 , COSA Fee $ ~ Date of Payment Receipt Number., (Rev. 11/05) Waiver Fee $ Date of Payment .. Receipt Number Dec U2 11 08:31a Dad 3388078 Pump & Well Service, LLC ; Aarow P o Box ~o~96 , ~¢ ,/// An~'t-;;'rage, AK 99511 ~I¢'. -~/~'/' Office: (907) 346-9355 - Fax (907) 333-8976 (' / Eagle River: (907) 622-9335 No. 9205 CUSTOMER F- JOB SITE L / L QUANTrrY DESCRIPTION PRICE AMOUNT / / ...... ;5. LABOR HOURS RATE AMOUNT TOTAL MATERIAL ~-' WOrK ORDER~ BY] DATE OOMR TOTAL LABOR PAY THIS AMOUNT ~%q/, ~ ThankYou SIGNATURE (r Hereby Acknowledge the Satisfactory Completion ef the Above Described Work and agree that {f above Work is not paid for in 90 days I agree to allow Aarow Pump & Well Service, LEO. 1he right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for e(~uipmentJ TERMS: ACCOUNTS PAYABLE AT lOTH OF MONTH FOLLOWING PURCHASE_ ~ERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS, C UZ ll Dad 3388078 ,-<~ Aarow Pump & Well Service, LLC . P.o. Bo×. 0496 Anchorage, AK 99511 Office: (907)346-9355- Fax (907)333-8976 Eagle River: (907) 622-9335 No. 9216 CUSTOMER · lOB SITE ~UAN~Y DESCRIPTION PRICE AMOU~ .......... ~._...~._~_ ~~ ~.~ ~BOR HOURS RATE AMOU~ .TOTAL MATERIAL WO~K O~DE~ED BY r DATE OOMP. TOTAL LA~ .ay t.~s amount ~~, ~ Thank You SIGNATURE Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that it above work is not paid for in 90 days I agree te allow Aarow Pump & Well Service, L, LC. the right Io remove unpaid for equipment and charge for labor already performed & labor te remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWII~6 PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. ASBUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE FOLLOWING DESCRIBED PROPERTY: AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESI:~NSIEIILITY OF THE OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS~ OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OF FENCE LINES, OR FOR ESTABLISHING BC~ND- ARY LINES. ASSOCIATES LAND SURVEYING 694~082q Municipality of Anchorage Development Services Department Building Safety Divislon On-Site Water and Wastewater Program 4700 South Bragaw Street P,O. Box 196650 Anchorage, AK 99519-6650 www,cl.anchorage,ak.us (9O7) 343-79O4 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING ParcelI.D. 1, Expiration Date: _~ - ~ GENERAL INFORMATION Complete legal description . Lot 11 Block 3 Klmberly Manor #2 Location (site address or directions) . 8001 Rabbit Creek Road, Anchora.qe, AK 99516 Current Property owne~-(s). Gerald & Barbara Harvey Day phone .345-8771 Mailing address .8001 Rabbit Creek Road, Anchora.qe, AK 99516 Lending agency Mailing address Day phone Real Estate Agent _Rick Jarvls ~.. ReMax Day phone .276.2761 Mailing Address _2600 Cordova, Anchora(le, AK Unless otherwise requested, HAA will be held by DHHS for plckup. HAA picked up by: 2. NUMBER OF BEDROOMS: ,4 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class. Public Water System Well 'PfPE OF WASTEWATER DISPOSAL: Individual On-site Individual Holding tank Community On-site Public Sewer The Municipality of Anchorage Development Sen/ices Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 5 by an Independent professional civil engineer registered In the State of Alaska. Certificates of Health Authority Approval are required for the transfer of title (except between spouses) on properties sen/ed by a single family on-site wastewater disposal and/or water supply system. DSD 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 sen/ed 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 sen/ed 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, 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 Health Authority Approval Guidelines for this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure Indicated herein. I further verify that based on the information obtained from the Municipality of A~chorege 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 .Pannone En~. Svc. Phone Address P.O. Box 102954, AnchT AK 99510 Engineer's Printed Name .Steven R. Pannone, P.E. Date Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious enDnecnng analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the peffon'~nce of the system under the conditions encountered at the time of ~4 the test, and separation distances measured to readily identifiable features. The operational life of all ~ wells and septic systems depend on the local soil condition, ground water levels that may fluctuate i ~', during the year, and the water usage of the family being served by the system. These conditions are ~utside the control of the evaluatur of this system. All systcm.s eventually fail and satisfactory test results ~ o not guarames future performance of the system, nor do they guarantee that there are no bidden dcfe~ or encroachments. PES can therefore not provide any wan'anty for future performance nor give any ~ ~ estimate of how long the system will continue to meet the operational requirements of the ADEC ~r ~x~ M~A DSD: The ~nt~nt ~f this rt~x~ is f~r th~ s~ b~ne~t ~f the ~w~er ~isted ~b~ve~ Any re~ianc~ up~n ~ or use ofth~s report by any other person or party is not authorized nor will it confer any legal right 4 whatsoever. - - v 6. DSD SIGNATURE [,'"'" Approved for JqL bedrooms. Disapproved. Conditional approval for 272-82t8 ~Steven ~. Ponnone,~ bedrooms, with the following stipulations: Additional Comments Attachments: HAA Checklist Septic System Advisory Well Flow Advisory X Maintenance Agreements Supplemental Engineer's Report Other Expiration Date: Odginal Certificate Date: ~- ~. ~ - O y Reissue Date: Municipality of Anchorage Development Services Department Building Safety Division On-Site Water and Wastewater Program 4700 South Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage .ak .us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L0f~ 11 BIo¢;k ~1 ~lmberly Manor Parcel I.D.: 0174)73-45 A. WELL DATA Well type P Date completed tqt~~''t2 Total depth ~..~3_~ft FROM WELL If A, B, or C provide PWSID # Sanitary seal Y Cased to 40'+ ft Well Log IN Wires properly protected Y Casing height (above ground) 1~ In. AT INSPECTION Date of test Static water level ~,CYI~ .,_ ~ ft Well production ,r,, v't.¥W,.~,~.~-t/ g.p.m ~iI1712004 1.~18 g.p.m WATER SAMPLE RESULTS: Coliform ~ colonies/100 mi Date of sample: Nitrate O-/DO mg/I Other bacteria Collected by: [.aur~ P~qnone ~ coloniesll00 mi B. SEPTIC/HOLDING TANK DATA Tank Type/Material ~gncreta Date installed 7/1611985 Tanksize 1250 gal NumberofCompertments~. Cleanouts Y Foundation cleanout Y Depression over tank N High water alarm NIA Date of pumping ~1912004 Pumper A+ H~me Services C. ABSORPTION FIELD DATA Date installed 9/12/~}~4 Soil rating (g.p.d./ff2 or.ft~)0.4 System type I~ed . Length 7~1 ft Width 40'~ftt~ Gravel below pipe .~ ff Total depth 3.5-4.5 ft E~fect~ve absorption area 2084.6t ft.= Monitoring tube ¥ Depression over field .0.. Date of adequacy test ~ Results (Pass/Fail) p~$~. For_4 bedrooms Fluid depth in absorption field before test~::~ in Water added'~'- gal. New depth '-~ !n. Elapsed Time: 0 rain Final fluid depth ~ in Absorption rate >=/~'g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) Nq If yes, give date (Rev. 11/99) D. LIFT STATION Date installed #/~ize in gallons/-""/Manhole/Access. "Pump on" level at ~ in High water alarm level at in Datum ,/~ Cycle{ tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tanldl~ station on lot 144 % Absorption field on lot 12~1 Public sewer main 100+ Sewer/septic service line 90+ On adjacentlots '100+ On adjacent lots Public sewer manhole/cleanout Holding tank 100+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 22 Property line ~10+ Water main '100+ Water service line 45+ Drainage 100+ Wells on adjacent lots IQ0+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line, Building foundation Water Service line 25+ Surface water '100+ Curtain drain None Observed Wells on adjacent lots 11)0+ Absorption field 5 Surface water 100+ Water main 100+ Driveway, perking/vehicle storage 50+ F. COMMENTS G, ENGINEER'S CERTIFICATION I certify that I have determined through field inspections end review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name Steyert R, Pannone. P.E, Date .~*'*/1 ~7 / ~ '~ No.C[ ~149 HAA Fee Receipt Number (Rev. 11/99) Receipt Number '~,1 ,;Z':~~~. :.~,:~".:~: . ~.. ':, ~ ' ~.-, .~.: ~ --- ~. ~ ~ ~' '", '" R6b . ~,~ _.:&~ ............ ~ err E Johns, dr. A Assoc. ~-~--~--~,''~'~"~ ~:.."' ~.~. : Professional Lond Surve rs ~~:.m~ ~. ~,-; ...... ~.~A~ ~ _ ~. ~ ~ ~ ~ 4,2 0 0 4 ~3 . ~'~'. ~'~ < ~t. · . ~*~ N ~/zl--5 ../..~ · ~ ~. zuue 2940 24094 D ~or ~ SURLY ~g ' PLOT P~NS ~ LOT ~R~ ': ' ~0~ .. Municipality of Anchorage Mark BtTfich, Mayor Building Safety Dix~ision I'.O. Box 19CW~=,O * ~7~) Bmgaw Street Anchorage, Alaska ~)519-Cffk~ h ti p://~av.m un I.org 5/26/2004 Pannone Engineering Services P.O. Box 102954 Anchorage, AK 99510 Subject: Waiver Request for Kimberly Manor//2 Block 3 Lot I I Waiver Request #WR040032 Parcel ID #017-073-45 HAA 040204 Dear Mr. Pannone: Your request for a waiver of the required I 0 feet horizontal separation from the Field to Property Line has been approved. The approved separation distance is 0 feet. This waiver approval applies to the existing Field to Property Line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, Jeff Poet Engineering Tech On-Site Water & Wastewater Program Municipality of Anchorage Development Services Department Building Safcty Division On-Site Water and Wastewatcr Program 4700 Bragaw Street P.O. Box 196650 Anchorage. AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 Waiver Review Worksheet WR#: 040032 PID#: 017-07~1-4~ HA#: 040204 Date Received: $12612004 Legal Description: Klmberlv Manor #7 Block ~ Ivgt 11 Engineer:. Pannone Enalneertl~fl Services P.O. Box 1029~4 Applicant: Gerald & Barbara Harvgy Permit: Waiver Requested: 0 Foot Lot Line Waiver aeoaraflon distance from Field to Property Line Criteria: Geology Points: A. Water Table B. Soil Sorption C, Permeability D, Water Table Gradient E. Horizontal Separation Total: Waiver is Granted: ~._ f Waiver is not Granted: List Conditions or Reasons for above: Rec#: 62569 Amount: $175.00 Date Paid: $126/2004 . I ,e/ . :.. ~*~¢ ~ ~'~'~,. Robert E. Johns, Jr. & Assoc. ~~...t --~ .14. 2004 2940 24094 . r~ s~uc~.~ ~T 'PLOT P~NS ~ LOT ~R~