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HomeMy WebLinkAboutTUXEDNI PARK BLK 1 LT 3Tuxednl'* Park Block 1 Lot 3 #041-022-03 MUNICIPALITY OF ANCHORAGE DE"""ITMENT OF HEALTH AND HUMAN SERIES • r a Environmental Health Division e y 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 e ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES '�2'e C' yjO stioaD Tp FROM SEPTIC TANK ABSORPTION FIELD WELL Z g00 ,8pyvir'EGcc X333 Vnonetsl .SGry'T3/ VetmnNo orEiezrOmrla WELL //o/-/- 140 lift 2s(No 337-GoZO LclrQLo(o 1 -4 LOT LINE r $s1 f GO PF /� 3s 4( - LEGAL DEeCRIVT14 - Lot B1OCa/ SUDDrviY°n/ �N� • Noe1G FOUNDATION /s�f 4�ff- 4o Ff rownsnry. Range. Section ^� I / to, _C (r C� .A&SUILLDIAGRAM .iLbow.iD�:atiLr I write tic sysiem_pr�rt ones, founaahon, driveway water I ocies. etc -Xq' TANKS N IlaI� J� SEPTIC ❑ HOLDING ManWactuier Cap eCily m gallons 2.50 ra.yur � �t e .I,'aGR Metendl No. of Companmenta TYPE OF SYSTEM TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER c Pe Ltepm 10 p.pe wttum bum Onginal grade total depth Irdm ongmai grade 2 Fr FT t?rk G/ Fill achfed aww. °ng -nal grade Gravel depth beneam pipe FT S F OIL! O VE F Gravel Iengm Jry FT Gravei wam I I Oldl absorption area / I Distance between lines s� o SO FT FT yJ '•�.• a a Number of lines I Soar rating E.. P.pe material �vG '• 50FT 3 �Nr ws;aner Date uutaueci WELLS 0 t, ` j PRIVATE ❑ OTHER (Identify) Gmmble:wn IA.N.CI 1 Ub1 Depth Lased to 77 FT '�-74/p Vr i ie insla� e� /-w202A LUOQ Date Ins avea 6-06-741, REMARKS: _A1C/��ravE / S7�atnr 4h /O�' „S� / I ��1/ •/. �i Hi 7L irC Scale:r<SOY Inspections Performed b ENGINEERS SEAL - �/� OJCp Date �+ 1 • eertlly that this inspection was performed according to all �j Municipal and Stale guidelines in effect on this dale: Health Department Approval: 72-013 (185) MUPA 3. (1; I^(AL I TY C7i AN17-F"�7FiAC3E DEPARTMENT'_.' HEALTH AND ENVIRONMENTAL rFROTECTION 825 L.STREET, ANCHORAGE, AK' 99501 ` 264-4720 C7N—S I TE E^,CWLF-ti F•E/RM I T PERMIT NO: 060266 UPGRADE Eng• �� Z( DATE ISSUED: 08/06/86 AP'P'LICANT: H.C. HAYWOOD ADDRESS: 2900 DONIFACE FKWY 4333 ANCHORAGE, AK 99504 CONTACT PHONE: 564-4316 LEGAL DESCRIP: �G IVISION "TUXEDNI"PARI. ''-----LOT -'. -3 "' BLOCK, 1' ei SLCIION: 6 TOWNSHIP: 12N RANUE: 2W LOT SIZE: 1.25A (SQ.FT. OR ACRES) I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY.MOA BUILDING CODES, THEN (1) AN ELECTRICAL,IPERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL. NOT BE AP'P'ROVED WI HOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WO': -MUST -FBF ONE PY A_LICEPJSED ELECTRICIAN. SIGNED DATE: _______ APPLICANT: FI. C. H 00 ' ISSUED BY -- DATE" f -_- o / �HLIt% isSlr/�u aFzyy i 57 -it Qnen 04M 6Qu4'Ccst e v Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: Z71 /`'"/�✓//JU UI/ LEGAL 1 (FEET) Q/tn..,GEQt.r SILTY 9Aw7 Depth to Water Net Drop NEW 2 HENS !ft "MNUMENNEW0 3 j 0:3o 4 G�f'1� V/Rn�P-/��uwrr S�c.T7'G?.cvrL 5 V j :In 6 ■ME,NE■.■■ C7 d �rurr'ge -brown Czv3al Y 6p,,ve-L 8 G'p v.//Sorra SonC� U 9 v zn NOMMEN EME■UMUM(i' 10LWAS GROUND WA ER -•� GLoCe _5 �• ENCOUNTERED] 11 GVv SP? : IF YES, AT WHAT 12 DEPTH? !D%/ �PoTTot,.t o� Tec7.,w Depth to Wrier Alun 7 i?I MonitorinD7 ___/ 13z_Bile: 7 -7r -r4, r%, ,,(ENGINt),LL- DATE PERFORMED: 7 -1=? -R(, le, Section: 14 15 16 itl 19 19 �, t-orilP/ Reading Date Grose Time Net Time Depth to Water Net Drop NEW , HENS !ft "MNUMENNEW0 0 rr 0:3o Z: 0 I NEMENNNENE q:3o :In ■ME,NE■.■■ C7 MENNEMEN ENN` zn NOMMEN EME■UMUM(i' (©NEOMMURNMEEMEMEREEME, �, t-orilP/ Reading Date Grose Time Net Time Depth to Water Net Drop Z-EZ6 n CD 0 rr 0:3o Z: 0 I „ q:3o :In C7 zn 20 -{ I „ lul PERCOLATION RATE � (mmutevinth) PERC MOLE DIAMETER TEST RUN BETWEEN Z FT AND /Z' FT COMMENTS - / 2/.S ��St lvns �YnT [� G/Lirw ��n .SYS�rm oi�S f ir✓, i/lt is/wo/ v 4!7,4 ,'�ir/r / l Si .%O �', Iy, /,. . // SF%ve .-r. rn.� �/ /3Sr f 2,G�'lir.:oY,. PERFORMED BY: ' "zwfxT G ' �%)'- `�e•1 CERTIFY THAT THIS TEST WAS PrArnnurn w ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE 72-008 (Am. 4/85) NAME LOCATION ._, GREh.ER ANCHORAGE AREA BOk,.JGH �r Department of Environmental Ouality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING ADDRESS LEGAL DESCRIPTION C-3 SEPTIC TANK: j"11 -4i 'DISTANCE "'NUMBER OF FROM WELLMANUFACTURE MATERIAL —COMPARTMENTS Z INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY GALLONS. TILE DRAIN FIELD:�� TOTAL LENGTH DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE OF LINES 2 NUMBER OF LINES I DISTANCE BETWEEN LINES TRENCH WIDTH I(k IN. TOTAL EFFECTIVE ABSORPTION AREA SQ. FT. LENGTH OF EACH LINE DEPTH OF FILTER t i� DEPTH: TOP OF TILE TO FINISH GRADE '31 MATERIAL BENEATH TILE S IN. ABOVE TILE IN. WELL: TYPE CONSTRUCTION BUILDING NEAREST NEAREST SEPTIC FOUNDATION_, LOT LINE , SEWER LINE , TANK_ CESSPOOL _ APPROVED_ DISTANCES: INSTALLED BY: SEWER LINE DEPTH: OTHER SOURCES DISAPPROVED REMARKS PIPE MATERIAL: LOT SLOPE: REMARKS: Form EQ -032 EPTH DISTANCE FROM: SEEPAGE SYSTEM_ DIAGRAM OF SYSTEM G.A.A.B. M Ll t+l I C I i L_ I T Y O F FF t4 C "pi lot DEPARTMENT C HEALTH AND ENVIRONMENTAL ATECTIQIR1v 2516 E. TUDOR F.D.. ANCHORAGE, AK. 99507 �•% � ��� 276-2221 C \. OTE SE4•JEFZ F„FF: FRM I T PERMIT NO. < 76455 > U APPLICANT HARRY HAYWOOD 6701 E 12TH 337-6020 LOCATION STUCt:H�ATrn-OV LEGAL L3 61 TUXIDNI PK SUBD LOT SIZE 55072 SQUARE FEET TYPE OF SOIL ABSORBTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = 4 SOIL RATING <50 FT/BR>= 125 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: C•EF'TH= LENGTH= S1 GF;ZnVEL ©E--_P-r"= THE LENGTH DIMENSION IS THE LENGTH <IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION CIN FEET). THERE IS NO SET WIDTH FOR TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION <IN FEET). F? =CALF I KE=E> SEF=TIC TFit4K S I 2TE= 1.Z>OiCA GF L -L -co n BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS 'DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR, A PUBLIC WELL. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS APE AVAILABLE TO INSURE PROPER INSTALLATION. i='EFS_t'1 I T tipnL_ I E> F= OFR C]tJE YEnFR F= F2Ot'F I _�uEz I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER. SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED ISSUED eonstzuctLon gest -fab "One test Is worth a thousand opinions". 2204 Clevel� %nd Anchor ge, Alaska 99503 Performed For f%Ar(,4 TTi4G1ltiOoe Date erfor ed 2- P-3 %6 Lenal nescrintion: Lot �_Bloci:_LSubdivision u 43. This Form Reports Soils Lon h mai Percolation Test_ tenth Feet Soil Characteristic 4 — /,u 7`er 6 ecQci�ec� N�eo�rt. 8 10 12— s ILfJ M L 14 u 16 — � � 1 18- 20— Was Crounl Water Encountered?/t/0 S/, QP If ves, At what Denth? 4" /V o i3e dl v c K F.v C0 V,V_`e14 Prnnosed Insta ation: Seenane Pit Drain Field Depth of Inlet Dent o ottom Of Pit Or rench Crmf'ENTS: /2-`— _ 6e Eft R CP B Test Performed By , /!^n Mpg r K _ Data Certified By: Date: J M U N I O I PAL I TY OF= NCHOFRAGE S�[wc�AGAc� DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECH ON 2510 E. TUDOR, RD.. ANCHORAGE, AK. 99507 276-2221 WELL PEFR r1 I -r PERMIT NO. C 76255 ) ,1 APPLICANT N r HJ9WlM � 6701 EAST 12TH AVE 337-6020 LOCATION CHENEGA LEGAL L3 61 TUXEDNI PK LOT SIZE 55000 SQUARE FEET MINIMUM DISTANCE BETWEEN A WELL AND ANY ON—SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 200 FEET FOR A PUBLIC WELL. 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=ERM I T krAL I E> F= OFR ONE YEAFR F= FROM I �S—LJE I CERTIFY THAT 1: I AM FAMILIAR WITH THE REQUIREMENTS FOR FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE SIGNED APPLICANT H C ISSUED BY ON—SITE SEWERS AND WELLS AS SET WITH THE CODES. r { wa l Log For.........................Harry ......C.....Ha .......ywood .................................................................................... Location ............ Tuxedni Park Subd:: Lot..3,i Blk. 1 ......................... ............... Datecompleted ....... :1.°.".e 28:..1976............................_................................................ Depthof Well .........77.:.........................................:................:.................................. 6" Size of casing ....... :.................................................................. :....................... .......... Distanceto water............................ ......:................................................................. Distance to water while pumping...... 21 Distance .....................................:at rate of 300 ............gallons per hour. Formation I from I to Clay, gravel I o' I 39' Sand I 39' i 4l' Gravel I 41' I 44' Clay, gravel I 44' ( 66' Sand gravel, water I 66' I 77' i I i I I I I I I I I I MUNICIPALITY OF ANCHORAGE " DEPT. OF HEALTH L � ... (i ��... ................. ENVIRONMENTAL PROTECTION Driller JUL S 19?b oq DECEIVED ABray3 Qyil`'] C!D 0521 GOLDEN ANCHORAGE, ALASKA 99502 PHONE 344.0651 Municipality of Anchorage • '-`l Development Services Department Building Safety Division Onsite Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.orglonsfte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 0 L41 - OAA -d =5 COSA# NO Q C -XP 0 1. GENERAL INFORMATION Expiration Date: 2 17-11107 Complete legal description Location (site address) Current Property owners) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TUXEDNI PARK SUBDIVISION• LOT 3, BLOCK 1 9611 CHENEGA DRrVE • ANCHORAGE. AK 99507 HARRY HAYWOOD Day phone 333-3335 9611 CHENEGA DRIVE • ANCHORAGE, AK _99507 Day phone 7731 E NORTHERN LIGHTS BLVD* SUITE 250 • ANCHORAGE. AK 99504 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual Well IN Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ TYPE OF WASTEWATER DISPOSAL: Individual On-site 0 Individual Holding tank ❑ Community On-site ❑ 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 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 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 riles 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 CARNESS ENGINEERING CROUP, Ltd. Phone Address 3701 E. TUDOR ROAD. SUITE 101 * ANCHORAGE, AK 99507 337-6179 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date ',S 04 Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational fife of all wells and septic systems depend on the local sof/s condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report Is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person orparty is not authorized, nor will it confer any legal right whatsoever. S. DSD SIGNATURE X Approved for 3 bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory Well Flow Advisory Nitrate Advisory X bedrooms, with the flowing Arsenic Advisory ., -c9 PN�a ���i/qN (1111111 Maintenance Agreements Supplemental Engineer's Reort Other By: ' Original Certificate Date: It 1Z'06 (R". 11105) Municipality of Anchorage Development Services Department Bulking Safety Division Onsite Water d Wastewater Program 4700 Bragaw Street P.O. Box 198650 Anchorage, AK 995196650 www.munLorq/onale (907)943.7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: TUXEDNI PARK SUBDIVISION; LOT 3. BLOCK 1 Parcel ID: 041- 022 -03 A. WELL DATA Well type PRNAU If A, 8, or C provide PWSIDN N A Well Log (YM) YES Date completed 6/28/1976 Sanitary seal (Y/N) YES Wires property protected (YM) YES Total depth 77 ft. Cased to 77 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 6/28/1976 10/20/2006 Static water level 22 ft. 23 ft. Well production 5.0 g,p.m. 5.97 g,p.m. WATER SAMPLE RESULTS: Coliform 0_ colonies/100 ml. Nitrate al&—mg./L. Other bacteria e) colonies/100 ml. Arsenio _AID ugA. Date of sample. 10/20/200 Collected by: GEG. Ltd. B. SEPTICIHOLDING TANK DATA Tank Type/Material SEPTIC/FIBERGLASS Date installed 9/10/1976 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES Foundation deanout (YM) YES Depression over tank (Y/N) NO High water alarm (YM) N/A Data of pumping 10/19/2006 Pumper McDONALD's PUMPING C. ABSORPTION FIELD DATA ea owisnNG CRAGE oN fee6 ENcN 9/10/1975 125 Date installed 7/24/1996 Sol rating (g•p•d•�'br� 13 System type TRENCH Length 53/54 ft. Width 4/3 ft. Gravel below pipe 5.0 ft. Total depth '12.4 ft. Eff. absorption area 530 ft' Monitoring tube YES Depression over field NO Date of adequacy test 10/20/2006 Results (Pass/Fall) PASS For 4 bedrooms Fluid depth in absorption field before test "0 in. Water added 667 90. New depth 0 in. Elapsed Time: 0 min. Final fluid depth 0 in. Absorption rate » 600+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N 8 type) NONE KNOWN If yes, give date — **TESTED 1986 TRENCH D. UFT STATION Date installed Size in gallons Manhole/Access "Pump on" leve�at_l�n.*Pump High water alarm level at in. Datu Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankfltft station on lot 100'+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/MOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption Held 5'+ Water main N/A Water service line 10'+ Surface water • 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line N/A Surface water .100'+ Driveway, parking/vehide storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ COMMENTS * SMALL ...A.. MADE POND WITHINWffH PLASTIC, HAS FILTER,.. l :A : N: SOURCE. G. ENGINEER'S CERTIFICATION I certify that I have determined through field lnspectlons and review of Municipal records that the above systems are in conformance with MOA COSH guidetlnes in effect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date if II.Y/04 COSA Fee S �/ 3v U 0 Date of PaymentT7/U� Receipt Number (Rs . 11/05) Waiver Fee $ Data Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description include lotblo block, subdivision. section, township, rang`) (address or directions) (b) Applicant Name /4.0,2 er A 4PW00, +elephone: Home 3'S 7" 40Z Business SZ4 43/(0 Applicant Address 4mCf%O.P.CGz�, AiC 995 (c) Applicant is (check one): Lending Institution O ; Owner/builder,; Buyer ❑ ; Other 0 (explain); (d) •L'egding Institution' `15t OWL Bak O3 At%9!A Telephone 0 .'Address (e) Real Estate Company and Agent NIR Address ' Telephone (f) Mail the HAA to the following address: 02 33'1- (0 oao 2. TYPE OF RESIDENCE Single-Family,e Multi-Faamiily ❑ Other Number of Bedrooms 4 3. WATER SUPPLY Individual Well Community[3 Public ❑ Note: II community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite Public[3 Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 411,84) n. n 5. ENGINEERING FIRM PROVIDING. SPECTIONS, TESTS, FILE SEARCH, DAT....ND INFORMATION As certified by myseal affixed hereto and as of thevalidation date shown below. I verifythat my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verity 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 /NA—T �'�SUL7T-ilNT-S /1 Telephone (C 9a0,2/ Address %77 STi7NFOr"� L/2 ANG</0�.4G�f�.0 7%'f�o8 Date 6. DHEP APPROVAL Approved for �.�r4i bedrooms by Date Approved Disapproved Conditional Terms of Conditional Approval CAUTION Engineers S'ea�. i The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP 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. Page 2 of 2 72.025 U 11841 S A. WELL DATA N MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 btU;:IcIPALITY OF ANCI1a;AO— DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION } 2 ('31986 2844720 -� 13 i t D Legal Description: ZoT - , Tux��r�: iii./c Well Classification ���y.47Z If A, B. C. D.E.C. Approved (Y/N) Well Log Present (Y/N) 1 ' Date Completed -OF- �& Yield-4��20,?h�" (7rS ird, Total Depth 77 Cased to `' %lo Depth of Grouting Static Water Level 2 S• S Pump Set At Casing Height Above Ground 2.S /n 3.O F� Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) /� Separation Distances from Well: / To Septic/Holding Tank on Lot ZzO Tf ; On Adjoining Lots i To Nearest Edge of Absorption Field on Lot /45-0 ; On Adjoining Lots i ZDU Ft To Nearest Public Sewer Line UNC To Nearest Public Sewer Cleanout/Manhole Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA To Nearest Sewer Service Line on Lot Date Date Installed Z �9✓76' Size ZZs0 No. of Compartments Standpipes (Y/N) / Air -tight Caps (Y/N) e5" Foundation Cleanout (Y/N) UN/G Date Last Pum ed I/y'� 8 es,� Depression over Tank (Y/N) P Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) — ;for Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well IZQ�•f f To Building Foundation To Property Line 8.S T7� To Disposal Field To Water Main/Service Line ��"d To Stream, Pond. Lake, or Major Drainage Course Comments Page l of 2 - 72-02611 V841 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �-3� f Zba7ido Type of System Design�f-Cp -;—r� Date Installed -7-4:v - F67 Length of Field 1512;e f/ � Width of Field Depth of Field /z / 7� ,i Gravel Bed Thickness -57 14f Square Feet of Absorption Area -5-.;2f ID Standpipes Present (YIN) Y Depression over Field (Y/N) Date of Last Adequacy Test NZ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well �¢d Z!&/t To Property Line To Building Foundation _ '¢� TTS To Existing or Abandoned System on Lot O170C�1 Fl� ; On Adjoining Lots To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Cutbank (if present) To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed . Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) _ Comments Dimensions Manhole/Access (Y/N) 'Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Check Permitted -Bedroom Rating Against HAA Request " Icertifyt/heat h �ked,v rifled,orconformedtoallMCAandHAAguidelinesineffectonthedateofthisinspection. Signet' l __V' / _ Date Company/ gyp!e:�IJS412LrtJrSMCA No Receipt No. __qOO I' 0c 30 Date of Payment O Amount: $ !v rJQ Page 2 of 2 72-026 (11,84) Engineer's Seal i r71 ; SPC _._ _� 54 , � • ! I New d�Q � i f..e.,eh sEcnoN a -a, �It T 44 f f. 'I /?(f Y -- '-Now drain i I � � ' Sacrio✓ $-�/ � I 8 /e &,e/7 ,v/enaA-' o.» tr Com - ,Ejr%JorJCY7 oil 1JLiO SOS �o,�e✓J ,G� J/�e O�vr-•c / A-11 C ile 114rlo"- ' � ficr�ofi c/. -o% /.tee s H YFS p �rR O �rrE 0 S' FENCE S E PT1C- — iJ WOOD WrAM o W' 2 LEvEL WOO FFAMF RE's. W/COwC O v O t FloUMO. • GARA BELOW 1 1 � 1 q 1.74 A ; PNgll 0 R I V U .110 SCALE I'•e S?7 • _ (,.7 it 10.0 STORAGE SHED ;:/B" t:CEAK WoOp DECK _ E G 'Kinr WKr_ i WCUp sztPs WELL. I$ 3 O I£ e1 t� 0 1 �#� �F �i� following described that property ccurale eurwy of the op� ....., S,f \ 1.07r 3 . emCK 1 • • y k "I'UX[DN11 PARK *:• 49th �: * see ,�pp • tras �,, on JULY 13. IqS(, and that IM Imprae' 'moots eltumed thereon an within the propertl1, lines and do not werlop or enuoach on the property frIng a0jacent thereto F* UE MAlfFIl M c, that no 1mprovaments on the properly lyin adjacent thereto M. 374}$ • � enaoah oe the Ngips In ewstion and I I there are no �� ••, •: 4; roadways, trammisalon tine er ether etsible easements on ........••. _6A sold property except as Indicated here^+. z PREPARED FOR, HARRY HAYWOOD AS -BUILT X- 7.13.86 2042 5614 15,XI-52 :K34 KARABELNIKOFF SURVEYING 337-3434