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HomeMy WebLinkAboutSUMMIT ESTATES BLK 3 LT 9SuLMMA l�'66 ^'0v5 -ori -a3 v�I Municipality of Anchorage Page I of 3 DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage. Alaska 99519-6650 • Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: �G`y�Q` O',lI q PID Number: 015 — o'7f - •a 3 Name: Wastewater System: ❑ New ❑ Upgrade OH A Address: ABSORPTION FIELD 54Ao _ PMOM: NO. 0! Bed ms'. Deep Trench G Shallow Trench 'Bed ❑ MounO O Other 333 — y LEGAL DESCRIPTION Soil Rating: � z Total Depth from original grade: GPDrS F, Lot: Blpda' Subdwelom Depth to pipe bollom from Original grade Gravel depth beneath 'pe y FI 3 Sr-e.aN trG 3 FI Township: Range: Sectinn: Fill added above original grade. Gravel length: Graval wrdlh Number Of IMPS: Distance ON.een Wet WELL: ❑ New ❑ Upgrade 1 .2- FI IF,. Classification (Private. A.B.C)' Total Doplh: Gaiea To: Total absorption area. Pipe malerial: G 03�l Ft Ft Fl hB/O Driller.. Date Drdlea: Slate water levee. Installers Dale IA" 1�n. 22 - FI yield: Pump set al: I Casing Height Apure Ground: TANK GPM Ft Ft. SEPARATION DISTANCES r/sephc 0Holding GS.T.E.P. To Seple Absorption Lal Hdmrlq ubiwp.te Manufacturer:�. Capacity In gallons: From Inas Field Motion Tina -er S.u. LLa.�'/'_I Well Ib 2 t 0 - _ 5 4,5 MalenaC S � Number of CO mpD rtmeMls: Surface LIFT STATION Water Lot Site in gallon^' Manufacturer' Line -1' D I B ..Pump on" level av ..Pump oil" Irwin at High water alarm at: Foundation L4 L 3 I Curtain Pnmp Mase b MMPI Eleclncal Inspections p111 by Drain BENCH MARK Remarks: Location and Description 1 G. Assumed Elwanon: c. ` . O — sgigbgOE.,pba MEFLGr"M - L S-9/. U 4 i :. .✓ ..w»:. 1� Inspections performed by: Dates: is ., „ Department of HLthand rvices approval �r , 071111k �t� Reviewed and approved b : Date: ,_I ._�-rr✓ ;•.; 72-013 law. anal) MOA 25 V I ? �P ' •. 49th...............ti._ BBCN SPURKLANB• /diff,•••• No. EE -2225 rf I I 1 •• ��PROfESS10 �i�• I �25 0 5 75 125 150 CALEB 1' = 50 FL — — — — — — - -¢- well I SWIN TIES. it'rlll 47 rT A e NEV 1000 GAL SEPTIC TANK 1 bt 44 I Q 4it 6 I BJ 82 A( 8z BIS 80 D NEW TRENCH 50 FT. LONG FT DEEP I 4 T. SEWER ROCK xisT.Ti '-NCH— — — — — — — — — — — — 1— — — — — — — — — 1 I I I I I I I I I I I I' I I Nell TOBBEN SPURKLAND P.E. LOT 9 BLOCK 3 SU.II.IIIT STATE SEPTIC SYSTEM , BUILT 203 W 15TH. AVENUE 5480 C. 98 AVE. DATE: AUGUST 311, 1995 ANCH. AK. 99501 GORDON HAMLL SHEET: 2/3 GRID: 1437 to exist. tank _ abandon d O4b�P 07 s 1000 gal Septic tank 2' Wide 50' Long 7' Deep 4' Sewer rock 3' Cover Monitor Clean Ou 2 Clean Out 50 T I NO SCALE Cleanouts 4' Topsoil r�zx94.51 3' Cover t I t -ro lP 90.9 Mira Fi 140 — 4 Ft of Septic Rock {s r th. i• TDBf N N SPURKLAND No. CE -2225 ••; Monitor 55 NO SCALE Gi,12195 101 - Exist. Ground 4' Min Cover 1000 got. septic tank BENCH MARK. BOTTOM SIDING ASSUMED ELEV 100.00 1UBBEN SPURKLAND P.L. L17T 9 BLOCK 3 SUMMIT ESTATE SEPTIC SYSTEM ASBUILT 203 W15th Ave GORDON HAZELL DATE, AUGUST 31, 1995 Anchorage Ak 99501 5480 E. 98TH. AVE SHEET- 313 GRID 2437 dGw� � D•2, a MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF 1 � 3Pm 8-a�•`�S ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT C1C+l5Y\ LD PERMIT NUMBER:SW950219 DATE ISSUED: 8/15/95 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. EXPIRATION DATE: 8/15/96 OWNER NAME:HAZELL GORDON S JR OWNER ADDRESS:5480 E 99TH AVE ANCHORAGE, AK 99516 PARCEL ID:01507123 LEGAL DESCRIPTION: SUMMIT ESTATES BLK 3 LT 9 LOT SIZE: 16181 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED ISSUED BY DATE-�G DATE: 08 !S SS T.SP"u-Ti[8KMAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT9BLOCK3 SUMMIT ESTATE GORDON HAZELL Ground Water @ 12.5 ft. Use Standard Trench Soil Rating. From test 7/26/95 2 min/in Use 1.2 gal per sq.ft/day No. of Bedrooms 3 Required Area per Bedroom: 15011.2 = 125 sq.ft.. Total area required: 3 x 125 = 375 sq. ft. Use 4 feet of rock Length of Trench 375 / 2 x 4 - 46.8 SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 50 FT. TOTAL WIDTH 2 FT. TOTAL DEPTH 7 FT. ROCK DEPTH 4 FT. COVER 3 FT. SEPTIC TANK 1000 GAL The installation of this septic system will not prevent wells from be installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface runoff will not result from this installation. pg.' EAST 97TH. AVE r 12 I t h / s EN SPURKLAND P� PRI]FESSION � 13 I 10 0 90 ' ' iso 200 I I I I I SCALE: i' d 100 FT. I EAST 8TH. E c� LJ � � I 11 I © I 10 I© — I ♦ \ EAST 9TH. AVE 1 � � 250 300 TOBBEN SPURKLAND P.E. LOT 9 BLOCK 3 SURVIT ESTATE SEPTIC SYSTEM DESIGN 203 W 15TH. AVENUE 5480 E. 98 AVE. 11 DATE: AUGUST J. 1995 ANCH. AK. 99501 GORDON HAML _ SHEET: 1/3 GRID: 2437 = 49th �0 • 0 I i„ .. TDA •EN $PURKLA •D ••SµY��i% I I I I 1,!pr No. CE -2225 I I I ., ;O PROFESS ��• • 25 0 5 75 125 150 •����••��� CALEB 1' = 50 FT – – – – – – — )fell ; I I I NEV 1000 GAL SEPTIC TANK I I S INSET TANK I NEV TRENCH I dANDON I V FT. LONG FT DEEP T 1 4 T. SEVER ROCK – – – – – – – _ – – - xis T. TiT .-NEI�J_ – – – – � – – _ – – – I SEPI I I I I I I I I I I I I Tfell I TOBBEN SPURKLAND P.E. LOT 9 BLOCK 3 SUMMIT STATE DATEE: : M AUGUST 3, tg,95M DIG203 W 15TH. AVENUE 5480 E. 98 AVE.DATANCH. AK. 99501 CORDON HAIELL SHEET: 213 CRD: 2437 to exist. tank _ abandon do 4b�1P `l 07 Q,es 1000 gal Septic tank 2' Wide 60' Long 7' Deep 4' Sewer rock 3' Cover Mon;tor Clean Out, 2 Clean Out IL NO SCALE Mira F; 140 4 Ft of Septic Rock Cleonout5 4' Topsoil 3' Cover NO SCALE 5.5 !� 49th Monitor 6. V. 8/2/95 SPURKLAND 0 - Exist. Ground 4' M;n Cover 1000 gat. septic tank BENCH MARK. ASSUMED ELEV. 100.00 IUBBLN SPURKLAND N.E. LOT 9 BLOCK 3 SUMMIT ESTATE SEPTIC SYSTEM DESIGN 203 W15th Ave GORDON HAZELL DATE- AUGUST 3, 1995 Anchorage Ak 99501 5480 E. 98TH. AVE SHEET- 313 GRID 2437 C�v�............ �• Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES r• •° °»'• %:::':'1. 825 "L" Street, Anchorage, Alaska 99502-0650 c SOILS LOG — PERCOLATION TEST r DATE PER FORMER PERFORMED FOR: �O�•d O'V7 J�R¢'.P� .•. `•�. ��..-- J • LEGAL DESCRIPTION: �L1496✓'�-gLlw.1;4 Township Range, Section: P� SLOPE SITE PLAN �l�f- f—I 2" 1111111S�1E 3 4 O S 6 - 6- 7 7 e c 8 - XOL) kt� Y'o r--40 9 `a o It 10 0 11 12 .r 13- 14- 15- 16 3 14 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? L IF YES, AT WHAT O DEPTH? P E 09th to WBrt Illtcr M9hibrilp? Date b Gross Reading Data Gross Net Time Depth to Water Not Drop Ra 10:b7 � !0 f• I!••Ot� :3 wbih 9 ' •.0 3 73� 7 's s/t3 PERCOLATION RATE � (mmutevmch) PERC HOLE DIAMETER TEST RUN BETWEEN ---Y- FT AND y/L FT COMMENTS PERFORMED BY: 1 CERTIfY CTI.�jT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE "�'�'L ' 6 1 �� R 72-008 (Rev. 4/85) Q r,;` GREh `ER ANCHORAGE AREA BOR JGH n • �,�� Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEW NAME MAILING ADDRESS J �c �d CA LEGAL DESCRIPTION E DISPOSAL SYSTEM PHONE: S SEPTIC TANK: DISTANCE NUMBER OF .Z FROM WELL MANUFACTURER MATERIAL COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY -LL -1- GALLONS. TILE DRAIN FIELD t TOTAL LENGTH n DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE OF LINES E NUMBER OF LINES I DISTANCE BETWEEN LINES TRENCH WIDTH_ IN. TOTAL EFFECTIVE ABSORPTION AREA DEPTH: TOP OF TILE TO FINISH GRADE SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER / MATERIAL BENEATH TILE _Sj_IN. ABOVE TILE WELL: TYPE CONSTRUCTION BUILDING NEAREST NEAREST FOUNDATION , LOT LINE , SEWER LINE CESSPOOL . OTHER SOURCES APPROVED . DISAPPROVED REMARKS DISTANCES INSTALLED BY: SEWER LINE DEPTH: PIPE MATERIAL: LOT SLOPE: REMARKS: Form EQ -032 SEPTIC SEEPAGE TANK- SYSTEM_ DIAGRAM OF SYSTEM IN. DISTANCE FROM: 6 "� W • O 1\ L o - . G DATE Q ?6APPROV ED - G.A.A.B. jr-1 II (' CF1 LL I TY OF At tC� {��F2t=lIM //:=�A�l DEPARTMENT HEALTH AND ENVIRONMENTAL �:OTECTION kl:wpiv- 2516 E. TUDOR P.D. , ANCHORAGE, AK. 99507 276-222 I TE :F.EL�FEF ~ REF= t1 I T L4ELL nr4E] PERMIT NO. C 76370 > APPLICANT DON DAHL SRA BOX 73 344-5720 LOCATIOtJ 'SUMMIT ST & EAST 90TH LOT SIZE 14175 SQUARE FEET LEGAL L9 B3 SUMMIT EST TYPE OF SOIL ABSORSTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FT/BR)= 100 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: OEF~TH= '-rD L_F=r4GTH= 20 U F,ti{EL_ I>EF"TH= THE LENGTH DIMENSION I5 THE LENGTH (IFJ FEET) OF THE TRENCH OR DP.AINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTAFJCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IFJ 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 (IFJ FEET). F<EGtU I F2EQ 'SEE: F"T I C TFIt-iFC 'S I 2E= 1 C1ci13 TWU t 2 ] I t4�FECT 101 " S nFZE FRFEE OU I FSEE> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTAFJCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL EU FOR A PUBLIC WELL. 13F1LLOit-1� BY THIS SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 F WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F�EF?M I T VFiL_ I o FOFR 01VE YEFfFc FF;;'rDM I SUE I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SE14ERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IFJ ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS RE110DELED TO INCLUDE MORE THAN 3 BEDROOMS. APPLICANT DON DDA�AHL ISSUED BYJ� ily --- .__DATE -------------- i EAST NINETIETH AVENUE Test Hole Locations in Summit Estates Subdivision, Block 3 Lots 9 s 10, Anchorage, Ak Test Hole Location are approximate and have not been located by survey methods. F. S. 0 0 ^_'EST HOLE LOCATION DIAGRA:i DW N' MA GRID' CKO FI&M CpNBULTANTS.INC. DON DAHL PROJ.NO. 656314 .. "«...... «��»» ��»� A11CRORAGE, ALASKA DATE: AY DWG -NO- A-01 SCALE: ti T}1-1 10-18-76 ORGANIC SILTY SAND, Dark Brown Boulder at 3' SANDY GRAVEL (GW) Many Cobbles Brown F GRAVELLY SAND (SW) occasional Cobbles, Brown Til -2 0.0 10-18-76 1.0' 7.5' 12.0' SAND W/SOME GRAVEL (SP) occasional Cobbles, Brown----- 14.0' SANDY GRAVEL (G11) Brown 15.5' GRAVELLY SAND W/ TRACE SILT (SP) Brown 19.0' TD No Water Table 0.0' ORGANIC SILTY SAND Dark Brown __ -- 2.5' Boulder at 4' SANDY GRAVEL (GW) Many Cobbles, . Brown Boulder at 9' GRAVELLY SAND W/ + TRACE SILT, aBrown No Water Table 19.0' TD These Logs represent subsurface soil conditions within Surmit Estates Subdivision, Bloc); 3, Lots 9 and 10 Anchorage, Alaska F.B. DWN+MAI? o o jDon T BOLE LAGS GRID: CK D' GZ qs.M Cay. gULTANTSINC. Dahl PROdNO 656314 DAT /a !y 7l' _ �... hora;e, Alaska DwG.NO. A-02 SCALE: "= 3' Qb'x7nt4 PLbarl -L-LSNu .su6hd. Ise S cV Em -Ahs cz,L:)m. J �- 136v7f"' #11611.� � i�zT 0 /1 c 61dzy l7 %Q l ,/J1t%li�P le�f�' r rl cJ�2L 11,e Ohlbr �//Xy - �7,1�ZG Z5 O i Gp tel,`, MUNICIPALITY OF ANCHORAGE • -� DEPARTMENT OF HEALTH 6 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. Y 015-071-23 HAA # 111i�`C� �-IX 1. GENERAL INFORMATION Complete legal description r or 9. Plonk 'Ac1mmit Fsra PC S. Location (site address or directions) 5480 East 98th Avenue Property owner Carl Swanson Day phone 1-907-733-2273 Mailing address Lending agency City 1:1:=I.,ageJ°a "IT ^ Day phone 263-0700 Mailing address 121 W Fireweed Ave., Suite 120, Anchorage, AK 99503 Agent Day phone Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX 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 xxx 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. n_=(FhAA1) FM MOA821 6. M1_ S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. i further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 8 5 ENGINEERING 17MI111 ''g Phone 6 c1 `I - act 7 q Address Eagle River, Alaska 99577 Engineer's signature DHHS SIGNATURE Approved for bedrooms. Disapproved. Date / O b vd '1 S' Z. VtZ�__ T„ 4 RCBERT C. COWAN IQ• CE -8801 Conditional approval for bedrooms, with the following stipulations: Additional Comments Date /0 - z 6 - 9 S 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 orderto 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-M m... wt) e.a MOA M . Municipality of Anchorage )C I l9 .r DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825 L Street, Room 502 a Anchorage, Alaska 99501 a (907) 343-4744 Health Authority Approval Checklist Legal Description: `O c" Le T q Q 3 Sv n n,T 1)7. Parcel I.D.: O 5' O 7/ — Z 3 A. WELL DATA Well type P R i v A T - it A, B, or C, attach ADEC letter. ADEC water system number Log present &N) Y s Date completed 1 / /d q / 7 6 Total depth q i r Cased to J} o f Casing height (above ground) Sanitary sea1&N) Y t 3 Wires properly protected (VN) Y 1 S Date of test FROM WELL LOG tl(a-q l'rc auto water level H 3 Well production 5 WATER SAMPLE RESULTS: • 0 AT INSPECTION to 7 g.p.m. Nitrate I • 6 g Other bacteria 0 9 -P.M. to t `/ 'q rd Collected by: S& S ENGINEERING Data of sample: I sRiver Loop Read Na 204 Eagle River, Alaska 99577 B. SEPTIGHOLDING TANK DATA Date Installed St (a s (' 9 S Tank size p e 0 Number of Compartments 1 ClearmtsO/N) Y f s Foundation cleanout &M Y 15 Depression Ale N a High water alarm (YO •` D Date of Pumping I q vq y Pumper A r C. ABSORPrION FIELD DATA Data installed re /#%,3 � % s Soli rating g.p d W fNltldmr) I • a System type Length S'0 I Widtit � , (;ravel tiUclmess below pipe Total depth Effective absorption area Voa sr 'Llytontioring Tube pnWrtd/N) YtlDepressionoartold(Yo ^ o Data of adequacy teat / o f' 17 A Y Results !°A S J For bedrooms Fluid depth in absorption field before test On.); I Imme�ately atter s6( gal. water added (in.): a r S Fluid depth a' 3 pns) Minutes hater. ! % Absorption rate a 15'0 o.p.d. 12 molts) (, /N) N o - i 'c . Q✓,✓ ff � give d$18 PerO)tide tn3atmerd (past 1N�"e 72-028 (Rev. 3198) D. LIFT STATION Date installed Manhole/Access (YM) High water alarm level at" E. SEPARATION DISTANCES Size In gallons "Pump on" level ar SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 10 > On adjacent lots Absorption field on lot 10 3 ' On adjacent lots Public sewer main N 1+ Sewer /septic service line "2 off" level ar 00 f Public Public sewer manhole/cleanout ^ /'4 Lift station N /A SEPARATION DISTANCES FROM SEPTICA40LOING TANK ON LOTTO: Foundation Lf , Property line a 0 Absorption field S Water mainiservice One / o .1 Surface water/drainage J o 0 Wells on adjacent kris /co ' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property one / o Building foundation /4 1.# - Water maiNservice line Surface water 1 *a '-r Driveway, Parldngivehide storage area Curtain drain N C 4 K^)a w ,r Wells on adjacent lots / D o v i F. ENGINEER'S CERTIFICATION / O ce aW that I have deteam/ned that Bald lnspectYons and review of Munk*W the are in cordomianas=v�1'tlr/NOA rend In effect on this date. Signature i.Qc (/ (J >!.• Engineer's Name k9I6 Ld.T' c g 01.JA✓ r`� ROBERTG COWAN f?- Date f o v 9 (y1 ` Bbtit . �fti` HAA Fee S 3 00 Date of Payment / D Receipt Number O 4z 117 72-028 (Rev. "a)" Waiver Fee $ Date of Payment Receipt Number '�• r 1 ( ..� -. , it IIPALITYOFANCHORAGE 1"f : I ? ),l, • i11 DPARTMENT Of,HEALTH b HUMAN SERVICES i, +4 it E xl®I t Vt ivislon Of El Services nvironmental NO{Og. lte`SOrVlce3'Sectlonr` %POFBox196650 orage;Alaska"`99519-6650 4 ^! 1 T� ! j ,,CEF{TIFICATE OF;HEALTH AUTHORITY (' tAPP OVALSFOFi'A SIN LE FAMILY DWELLING h S 1 i.i II ,!i ! 4 t,.♦ I all* r 1;L71F I t Ir t1J fr �, 31 HAA '# Parcell I.D. #j CI5 D'11 r ltt {� f +, 'OENERALINFORMATION�3rlj� x va1L, ai, r a,t-ts? (f • i 1= STAT- C ` q dt, r r i ,FS iii t 1 Complete legal descriptioni� G• ` , '�• [. J>'t,• i l , , 1 } .r1- i S.�'lc .'I ,J.. e p X 1 C77777777,=,1,; 'tlw.,; �Hl 11R7 i�0 '�'I=' MV''r i 1 Location (site address or,directions) f , `�I J �' a vl� a } phone Property owner I tGo1,Y� iu i (} �zjr z r, —Day h' �3 3 + -,i ti' Mailing' address—'$ rs YI {I,!4,.ycy w �, S r 1 S" •..-i •r 41 r. r¢ w 1'.r.,f, }1%1 'ti.�e rllr'Z.i,,11{f /w j•-(nv-•�aku: Day phone Lending agency ' ��Malling address' ,• tl,t i 1,f Daayy phone q 4 Iit rJ•I 1 J he be d for pick ` 1 Unless otherwise requested, HAA' Wi t I I t P r , riM t, ify'i {� .. ',I. isid y'1 n.. 4tv,....� 2 NUMBER OF BEDROOMS,` <-x rI + 3... TYPE �OF,WATER SUPPLY;,, 1 1 tr�x • L{ir •.. . , .,. E F-�J. 1 i � + �x t {Z -K+ L�,✓ q'Ts ult>• if �1.f' 1�d �' ` ' �' h 1 J 1 u.rF { p - I Ind�iSvidual `,;t: h,'r r ti • f"• ^ oii$5513'i Community Weil.' 7 ��IrM ,•. ` { � � }r {.1111, Y. I- ♦ Ara.. r..f ' s++G 1im' 1 4 r�. f , ,l.t 1.11r , i ( t' a�aa". -�� :�,jd,,~~•t - , 1!'• Public water,,, .� N I 1 confirmation from ADEC-attest A NOTE. If community well sys(ep«ovf d@ Written corlflrrn ; Ing to the legality and status of system t' 4.'. TYPE OF WASTEWATER DISPOSAL: ' u ` Individual on site' �f15 L t r l , 'N I� P , 4 n1'" . , '1' ? 1 a+' J 4 1i�1 `.- �\�•; . Holding tank's-" ,l ` lil, "t i•: .t'II• I. ,1rw,Ju� .r, t'41 1);,7-+L '144 4, , Community on slSeE - . !' I r i } } 5 ! r w•, F r to , +, � ..} ' t .. ' x � 1� -. I . ' L:. S) i . c u a "Public sewer,, „ , � ,t,) , 1 J, , 1 ,4u '6'f;,r: i " t r rovlde wrltten`confiimation from State ADE NOTE: 1/community�wastewa�tersystemhp r..werrt 41 ' : ''attesting to the legality and status of system ' r, i ,! '+o 'i'!4, 'r'1 i!t" M',r ill t ^'I �� dl "? l�t'i, 17i-0231p.v vol) imrN'IAOA1120- l If I1., .=,,11,1,"•11 �1.%, , .. .r 1.� t 1 5 ' , STATEMENT,OF INSPECTION BYI ENGINEER 1" Ii.c , >;:1, j.>.'J'i{.:I i. IN 1f i" i i As certified by myself affixed hereto and as of the validation date shown"below; I verify that my' lnvestigation of this Health Authority Approval application shows that+the'"on-site'water supply `J " and/or wastewater disposal system is sate; functional and adequate for the number of bedrooms and type oistructure indicated herein �i furtherverify that .based 'on theInformation obtained from + the Municipality of Anchorage fl an from my investigation' and Ins a 1 ' r r • ,J , .t'I pection, the on-site water supply and/or.wastewater disposal Is is In.1 with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection Name of Firm l o f�b.t Phone 9 39 3 Address _—Lea, rYi / 5 Lti '"i t� o s t i' ,f .. J ., • r . �j � �uil. ,Qk 9450 I Engineer's signature' �]�tJJVJ�'`IJ ,:f1 p: •r9 / Date'' r �Of •>.-.Za�%gw i F I' i I a r IJ°J '" !'.J�i�jL +i�Y1 {�'. i� y �I�GJt( ^ j,•rp • �• . r ( ' t t, [ ° Iitl , df, iu i° 'wj i,-4/ �' `,'!r.p •iu•n N.a. / 4 1: 4: 23. 6.' DHHS SIGNATURE �; '' r r �t •,r,?t ,1 •+ e rr�' 1, 4. a •+ y.. . t 1 .. S'�-S. 1 , ` 41 f � 1LLp°�r;l, n•, -•Y✓ , Approved for J Ty;bedrooms I r 11 i �.: i ♦ 1.,1 11 Y.I ,f i !1 i xt I_ •! J f ), ' • I r 'Disapproved c ; 1 r r 1 1 T �. A ,[ .; i,� , 1 r. i 1 r f r r�' �1 +nf � Ft, -n J .yy 1 '• .Conditional approval for radr; 11) f; at•r r'gr(I 'fr °IJi 71 1 h 1 I i bedrooms, wRh the following stipulations.!, 1 I is -a .1 q:.f le „; �b.1.Iai• tfl,j. iiJ>i i -;.i ;'�•i ' , "Additional Comments •'• ' . i,.: iF,'+r,� r,'r 1 i�jli ! �•e��`1LL� J, r •'. ( l` , '.f • t 1', ? 7 V`„ + frit. � :By.. 2-: L--• .1` ..I 1 , °v ,. ! , ` ' ' Date r. r, .L�j..•�• ! ° Y , fCi P'',..t ll'/' •",�ft I 1p `My ,11i .!. '�y1 .I:1'�.Ywl i.•f!d'a..:N..'L7iwf+•AIJ (,t'.wIIJ•`1'1 I' ... t l CAUTION ,1 A .. _. •-[ •-.a da° tYn +",V tl a r F «p}ice v1a w <.vyw the Munlcipality'bflAnchorage Department of Health and Human Services (DHHS),issues°Health Authority i Approval G'ertlficates based only upon the representations given In'paregraph 5.above by,an independent 1 professional engineer registered In the Slate of Alsska.�The DHHS does this as a courtesy to purchasers of homes and their fending institutions in order to satisfy certain federal and stale requirements Employees of DHHS do not + conduct Ins yZ.. f. pections or anal a data beforela,certificate'is Issued.rThe MunicipalitY;of Anchorage is not responsible for errors or omissions In the professional engineer's work. I " .. ” ,�li 1 r•2�. '1 fI �'. .i'11• {t.J '),t li 1"1,{P � .. 17 J 72-0Y. (Mv. 1N1) B¢y MOA 121 ' r y 1 r 3 y ,. f 1 1 � t. yi •4'l�l• � Municipality of'Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division ! 825"Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 L' Health Authority Approval Checklist Ig � c LP TG Legal Description: Lei Q `iK S �a u. wi £s W a Parcel I.D.: 015 — 0 71— 23 A. WELL DATA i Well type if A, B, or C. attach ADEC letter. ADEC tvatcr system number N�A _ . 'ay �/ �� fr c'a Log present (Y/N) / Date completed X 112 i j 157 1- Casing height above round) t Q ,t Total depth q 3 Cased to q 3 g g( g Sanitary seal (Y/N) �� Wires properly protected (Y/N) FROM WELL LOG Date of lest t t� 29 li b Static water level 4S Well production 9— p.m- AT INSPECTION 39 *7 z g.p.m. WATER SAMPLE RESULTS: Coliform Nitrate Other bacteria_ _ 1 Date of sample: 81p�3I9� Collected by: S B. SEPTIC/HOLDING TANK DATA Date installed 6 z3�4� Tank size io-t� Numbcr of Compartments �_ Clcanouts (Y/N) ! Foundation cleanout (Y/M _ __ Depression (Y/N) NIA High tvatcr alarm (Y/N) rv�A Date of Pumping N a Pumper I'l/A C. ABSORPTION FIELD DATA Date installed R/2 2[Q i Soil rating (g.p.d./R' or (t=/bdrm) i.2 System type Length 5J Width Z Gravel thickness below pipe _Total depth '— Effective absorption arca 4100— Monitoring Tube prescnt(Y/M4-1— Depression over field (Y/N)IN Date of adequacy test N/Ls Results (Pass/Fail) —?_ For / bedrooms Fluid depth in absorption field before test (in.); Tq11_ Immediately after gal. water added (in.): Ci /4 Fluid depth Minutes later: N�/s (in.) Absorption rate = N A P•d Peroxide treatment (past 12 months) (Y/N) tq If yes, give date D. LIFT STATION NIA Date installed ' y� Manholc/Acccss (Y" Iligh water alarm level at* (-•cics tested E. SEPARATION DISTANCES Size in gallons "Pump on" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: "Pump ofi' level at* Scptic/holding tank on lot 10.2,.: On adjacent lots > r v -O Absorption field on lot 10-5 ; On adjacent lots 7 / U` O Public sewer main NSA Public sewer manholc/cicanout N�/y Sewer /septic service line Lift station N//4 SEPARATION DISTANCES FROM SEPT7C(HOLDING TANK ON LOT TO: Foundation Property line A0 Absorption field Water main/scn•ice line __Surface water/drainage rj�o Wells on adjacent lots / ta•-O SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation 31 Water main/servicc Zinc G 5 - Surface Surface water 410 Driveway, parking/vehicle storage area 150 Curtain drain N 0"e— Wells on adjacent lots > /ero F. ENGINEER'S CERTIFICATION / E' �-/ K c /�� ,�T-i I certify that / have determined thru field Inspections and review ofdfunicipa! records shat the obove systems are`, in conformance with AfO,t f/M guidelines in a ect on this date. �. r•,. '7 Signature c Engineer's Name Date � Oi�t HAA Fee 1�bD (ID Date of Payment Receipt Number6 —T� Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number IR ° Rrn n1�ti P %t.N' ' DEPT. OF HEA�Tj1 L� MUNICIPALITY ANCHORAGE p1� fit-+ DEPARTMENT OF HEALTH 8 ENVIRONMENTAL FROTEC�TI�E��"T"t Tp S3E L Street • Anchorage, AInW SS601 UI L J 19w! O • ENVIRONMENTAL ENGINEERING DIVISION RECEIVED Talephone 2844720 REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complex all parts an papa 1. Irreenplate ragenra will not be pPyne allow ten (101 days for Praewtirq. PHONE 1. PROPERTY OWNER 341q_.S` % 7— _'0V _,S/ PX16 f/ , '00P le AV .276 - S. LEGAL DESCRIPTION STREET LOCATION ' NUMBER 0. TYPE OF REBID NCE ❑ f�+ e ❑ Four ❑ Other INGLE FAMILY M,—,Two ❑ Five ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER EUVLY ' ATTACH WELL LOG. A well log is required for all wells drilled G9F'0 INDIVIDUAL* June 1978. For wells drilled prior to that date, give well ❑ COMMUNITY ❑ PUBLIC UTILITY since depth (attach log if available.) 6 SEWAG�EOJIgPOSAL SYSTEM r7 **If installationdate l[! INDIVIDUAL/ON-SITE" If system it over two 12) years old an adequacy test is required system is over two (2) arsold ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED, 72-010137781 Slate ` yp- & t..... ^ nmo- . 9 r THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS DAT 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX 0 OTHER SUPPLY PERMIT NUMBER DIVIDUAL DEPTH OF WELL MMUNITY BLIC UTILITY DATE DRILLED FAR nnection Vefified LOG RECEIVED E DISPOSAL SYSTEM PERMIT NUMBER UAL/ON -SITE UTILITYon TALLED Verified Z �.^ERank or ❑Holding Tank ENA Size: _/ DDD If Tank is homemadeTING give dimensions: JWC� .QcT NK MANU CTURER L ABSORPTION AREA MATERIAL STANCES Lft�pllon Septic/ olding ank Absorption Area Sewer Lina Nreet a WELLTO: ne Area to nee,mt Lot Line MMENTS VI 'APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ��DISAPPROV ED DATEBY (Title) LEGAL DESCRIPTION 72-010 (Rev. 3/78) MUNICIPALITY OF ANCHORAGE,—) DEPAR825r 'L Street, AnALTH chorage, TION chorage, Alaska -99501 279-2511, ext. 224 or 225 #1: Time _jj3A_RM_-_ #2: Time Date 4-19-77 Wed. Date Insp RCPrattInsp Insp_ ---- REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Date Received: April 19, 1977 #3: Time Date 1. Lending Institution Request: Alaska Statebank Mailing Address: 310 East Northern Lights Blvd. Phone: hl Construction Phone: 344-5720 2. Property Owner: Da Mailing Address: Star Route A Box 78 99507 3. Legal Description: Lot 9 Block 3 Summit Estates - see map on back of this one, meet Don Dahl at this one. 4: Single Family Residence: (c) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Permit # Construction Public/Community System: ( ) Individual Well: (x)c Depth of Well 120' Well Log on File ( ) Bacterial Analysis 6. Sewage Disposal System: On-site System 6() Public Utility ( ) Permit # Installed 1976 Installer Septic Tank Size Manufacturer Absorption Area Soils Rate Material 7. Distances: Well to Septic Tank to Absorption Area to Sewer Line Nearest Lot line Absorption Area to Nearest Lot Line rage,XIVro Department of Request for Approval Health and Environmental Protection of Individual Sewer and Water Facilities Legal Description: Lot 9 Block 3 Summltt Farataa Subdivision Comments: Affadavit Attached: 11) Approved: Disapproved: Department Worksheet: Letter Attached: ( ) Date: Date: (--,f.jU,,,jjCjPAL1TY OF ANCHORAGE�� n )epartment )f Health and Environment& 'Prp �,Rof OF ANCXOV�,E 825 L street, Anchorage, A] '.C�. PT. Or �.MMMFNL%L PkWPICN. 279-2511, e -1t. 224, 225 roval of individual Sewer and Wat*'"bllb�fg t for APP � 0� 11, // P-"A_U�v � 1. property Owner: �Phone : 0, mailing Address 2. Name of Buyer: Phone: Mailing Address: 3. Lending Institution: C Phone: Mailing Address: __vz 1�4 4. 5. �11 Realtor/Agent: Mailing Address: Legal Description: Street Location: Phone: Single Family Residence: j.jultiple Family Residence: �4 Number of BedrOO-Ms: ( ) Llumber of Bedrooms: 7. Water Supply: * Individual Well Y) Public/cor-munity system if individual Well, well depth _LZI-0— if community system, name Of sYstc-',' Sewage Disposal SystOln: on-site System Public system System, date of installation: ILE On-sitc is required on ALL wells drilled since 6/75. *NOTE: well log 3/77 MUNICIPALITY OF.ANCHOP.AGt .-: p ::DEPARTMENT OF HEALTH AND ENVIRONMENTAL`PROTECTIUN �\ 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 i aU �� o ✓ I I ��p� 2d Date Received: March 15, 1977 3' �I o d _ 1st Inspection: Time •2'.�� Pf11 2nd Inspection: Time Date ��•^!1-�7 �yPi?I Date . Inspector � Inspector REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND 1*IATER FACILITIES .l. Lending Institution Request: Alaska Statebank Hailing Address: Post Office Box 290 Phone: 279'7637 2. Property Owner: Don Dahl Phone: 344-5720 Mailing Address; Star Route A Box 78 99507 : Lot 9 Block 3 Summit Estates Subdivision 3. Legal Description 4. Single: Family Residence:" (x) Number of Bedrooms: Multiple Family Residence: ( ) Number of Bedrooms: (f'.- Depth Well Log Filed ( ) 5. well Data: Type '�1rdivtdUal Construction Bacterial Analysis G. Sewage Disposal System: On-site system (x) Public Utility ( ) Permit f. 76870 Installed Septic Tank Size Absorption Area 1976 Installer Manufacturer Soils Pate 7. Distances: Well to Septic Tank to Sewer Lines Nearest Lot Line Absorption Area to Nearest Lot Line Material to Absorption Area Page Two DepartmeHealth 2ndividualEnvironmental Waterectin Facilities Request for Approval of Legal Description: Lot 9 Block 3 Summit Estates Subdivision Comments: Affadavit Attached: ( ) Approved:% Disapproved: Department Worksheet: Letter Attached: ( ) Date:_ Date: 72003131781 ^ MUNICIPALITY OF ANCHORAGE • ` DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL ENVIRONMENTAL PROTECTION PROTECTION. DEPARTMENT OF HEALTH AND 99501 MAR 15 19771 i 825 L Street, Anchorage224sk225 t , REQUEST FOR APPROVAL OF RECEIVED _ SEWER and WATER FACILITIES INDIVIDUAL Match 11, 1977 IDC VA—FHACONY — 1, Type of Inspection: Don Dahl 2. Property Owner: 344-5720 SRA Box 78. Anchorage Day Phone: Mailing Address: 3. Name of Buyer: same Day Phone: Mailing Address: Alaska Statebank 4. Name of Lending Institution: 279-7637 Box 240, Anchorage Phone: Mailing Address: na 5. Name of Realtor or Agent: Phone: Mailing Address: Lot 9, Block 3, Summit Estates 6. Legal Description: Corner of Summit & 90th Avenue Location: Single family No. Bdrms. 2 Si —�-- 7, Type of Facility to be Inspected: B. Water Supply well Type of Supply: Public Utility_ -----Individual one If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System septic (on-site) Type of System: Public Utility—Individual 1976 If Individual, date of installation 72003131781