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HomeMy WebLinkAboutROLLING HILLS ESTATES BLK A LT 6Rolling Hills Estates Block A Lot 6 #011 -072-20 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: OSP251132 Work Type: Septic Upgrade Tax Code Number: 01107220000 Site Legal Address: ROLLING HILLS ESTATES BLK A LT 6 G:2124 Site Mailing Address: 7238 VIOLET PL, Anchorage Owner: LAYOU BRENDA Design Engineer: GARNESS ENGINEERING GROUP LTD This permit is for the construction of: Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 5/9/2025 5/9/2026 33000 ❑ 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: G E_ G Date: Issued By: Date: 5 Z 3 ON -SITE SEPTIC/WELL PERMIT APPLICATION Parcell.D. 011-072-20 Property owner(s) BRENDA LAYOU COI JORDAN ANDERSON WITH AGES Day phone 907-223-2305 Mailing address 7238VIOLET PLACE, ANCHORAGE, AK Site address 7238 VIOLET PLACE, ANCHORAGE, AK Legal description ROLLING HILLS ESTATES; BLOCK A, LOT 6 Number of Bedrooms 3 Engineering Firm GARNESS ENGINEERING GROUP, LTD. Building Permit Number Not Applicable FN APPLICATION IS FOR: APPLICATION IS AN: (XI all that apply) Absorption Field 0 Initial ❑ Septic Tank R Upgrade 0 Holding Tank El Renewal D Privy ❑ Well 0 THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Permit/Rush Fees: Date of Payment: Permit No. 0 Sp P, Waiver Fees: Date of Payment: Waiver No. Distance: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251132, Curtis Townsend, 05/09/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251132, Curtis Townsend, 05/09/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251132, Curtis Townsend, 05/09/25 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP251132, Curtis Townsend, 05/09/25 N N N W r LO 0) 00 3JV7d 13701A ,Z6'6b d 3„0£,ZO.O N Qz W 3 0 0- W e 00 w u E- U _L _ J h 3 oz � M � w W U N II p W p J W W L m W LL W 6 en 2 Lou Y� p �b31 -- v O SYZ I 160 ( �E'I ti 3Sn0H1f 7/1,Vb3379N/S o W IN O�6 I� 562 � N 2 r__.`__ 37N3j DOOM NOON a.3savH3 N w O Q 4 to 5 w 2 2 �O O 00 ° co uo�o 1� O 2�200 W S� 2 62 24A 1 �7 �Ol N637 z 4' 2 1z s i 160 Q"• i— G Of) L= O F- LLJ zcn Q J O�o �. a W z �WtE ?ate Y=Q FZ- N W Z VFW F m �Nm r V1 [n Uj fn I � ❑ Z N zzz u Cq wau O ZO W W fin. 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Laboratory, 945 Sixth Ave. z Tueskr, tt'ednesday INDIJAL WATER SUPPLY ALASKA DEPARTMENT OF HEALTH Section of Sanitation and Enrineerinr Re uest for Bacteriological Analysis Please Look on Reverse of Sheet for Sample Collection Instructions. 9 lab No .r^ Water sample collected bY...../L ./ 1,` h S -6 i"'t�.. (.... l.. Y..�.... N..../. �.�.Q ... :....................................................._.. ............._ . (Name of person co�ting sample) II (Time) Water sample collected from 8-f0tchen tap; ❑ Bathroom tap; ❑ Basement tap; ❑ Other (list).............................................................................................................._..........._... .r..vv.. ___E� _�� r"r _ .+ � � c I � � r i r - �t•�'i�+ A—, 7' r� rADH-HSa6P1(1) (4M) S La1, No 12536 / INDIVIDUAL WATER SUPPLY ALASKA DEPAR'T'MENT OF HEALTH Sotlthoentral Regional wra I Section of Saniution.and Engineering orris ACTION ON REQUEST FOR BACTERIOLOGICAL WATER ANALYSIS Your recent request for an analysis of a sample from the Individual Private Water Supply sewing ?? / :1 was received 9/11/60 t examination has been completed Mr. Thomas Ooresen Pe 0. Sax 41195 Spenardp Alaska Records in this office indicate this Individual Private Water Supply to be of_._Satisfactory—Questionable_Unsatisfaaory salutary status. Analysis shows this SAMPLE to be faaory. Questionable Unsatisfactory. If an "Unsatisfactory" or "Questionable" status is indicated above, you should take immediate anion as recommended below. 1. Boil or chemically treat your water supply to protea your family from water -borne diseases as outlined in en. closed leaflet, "Drink It Pure." 2. Improve your spring—See bulletin HSE -6-2 3. Improve your astern—See bulletin HSE -6-3 4. Improve your dug well—See bulletin ILSE-6.4 5. Improve your driven well—See bulletin HSE•6.5 6. Improve your drilled well—See bulletin HSE -6-6 7. Relocate your well to a safe location in relationship to your sewage disposal system—See bulletin HSE -15 8. Bottle broken in transit, please send new sample. 9. Sample too long in transit•, sample should not be over 48 hours old at examination to indicate reliable results. Please send new sample. 10. Contact your nearest ❑ Local Health Department or ❑ Alaska Health Department, Sanitation office for bulletins, consultation, and assistance. 11. This is a surface water source and subject to pollution by man and animals. An approved water supply source should be developed SANITARIANS REDiA1tYc Signature SAMPLES MUST BE SUBMITTED IN CONTAINERS PROVIDED BY THE ALASKA DEPARTMENT OF HEALTH DIRECTIONS FOR'•COLLFCTING SAMPLES OF -WATER FOR ILACTF.RIOLOGICAL EXAMINATION Read Carefully and Follow Instructions Exactly i DO NOT COLLECT. SAMPLES. FROM FIRE HYDRANTS, YARD HYDRANTS. DRINKING FOUNTAINS OR SIMILAR OUTLETS WHICH ARE DIFFICULT TO D I S I N F E C T PROPERLY Bear in mind that water analysis deals with mateilals present in very minute quantities. The least carelessness in collecting and handling may, give rise fo results which are misleading. I i I II ' Arrangements should be made to have water samples reach the laboratory, as quickly as possible. After 48 hours the significance of the bacteriological analysis ,is ,impaired. For obvious reasons the laboratory prefers to receive samples in the early part o1 the week, but is willing to accept samples at any time. { In collecting samples from TAPS or PUMPS proceed as follows: (a) Thoroughly flush tap or pump by allowing •Vater to run freely for five minutes. ' (b) Shut off water and ''flame the'outlet with torchor burning paper.' The flame should not be merely passed over the outlet,' but should be' applied until fixture shows Indication of being hot. Flame should be directed against Inside edge. .i• (c) Open fixture so that a small stream flows. (d) Remove bottle from mailing tube.. Hold bottle by the lower half in one hand and with the other remove the screw cap with the fingers, leaving .paper protecting cover in place. Fill the bottle to the shoulder. Replace cap with, paper cover, screwing firmly into place but do not apply pressure which will split cap. (e) Pack bottle carefully in mailing ,tube enclosing this completed information sheet, being sure that a simple sketch Is included. In collecting samples from STREAMS and RESERVOIRS proceed as follows:, It. (a) Remove cap and hold bottle as described under.(d) above. (b) Collect sample by holding bottle :ln a slanting position and sweeping it below the surface in such a manner that water that has been in contact with the hand Is not introduced Into the bottle. Avoid collecting surface scum and bottom sediment. S" PLES MUST BE SUB3HTTED IN CONTAINERS PROVIDED BY THE ALASKA DEPARTMENT OF HEALTH N J.57 OIA w w Ol W z Hl nom: 0 • �sIz �� I i� t Q / � ' N �' � 1l� •C • \ i • r 1 1 W W .•. O0 C1 r� L/ W Z Q0:WW ¢ ZZ `1 0Z I. 1 Z Y 74 i 1 7 NI i n6+/: 1'6 fi I t N13'OA/ o•�aw� C a LL. C) K J 0 • t�• ` 1` l ala>a�a�` QQ so, W W .•. O0 C1 L/ W Z Q0:WW ¢ ZZ `1 0Z I. Fou) Z=0 W,00 ;/ WNz• '' si QNQo ¢w¢ Municipality of Anchorage Development Services Department Building Safety Division On -Site Water 8 Wastewater Program _ ^ 4700 Bragaw Street P.O. Box 196650 j Anchorage, AK 99519-6650 www.muni.orglonsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL .rf�ry FOR A SINGLE FAMILY DWELLING Parcel I.D. fel II _b7d_aD COSA# DOb�J"f 'f 1. GENERAL INFORMATION Expiration Date: Complete legal description Location (site address) Current Property owner(s) Mailing address Lending agency Mailing address ROLLING HILLS ESTATES: BLOCK A, LOT 6 7238 VIOLET PLACE • ANCHORAGE. AK ' 99502 STEVEN PRADELL Day phone 227-2511 7238 VIOLET PLACE • ANCHORAGE. AK • 99502 Day phone Real Estate Agent NANCY BERGH POLLOCK Day phone 762-5818 Mailing address Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ 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 engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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. 1 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 GARNESS ENGINEERING GROUP, Ltd. Phone 337-6179 Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Date 101,63 Engineer's Comments: In conducting this evaluation, GEG, LID. attempted to provide a thorough, conscientious engineering analysis of the system In accordance with ADEC and MOA DSD Guidelines B 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 life of alt wells and septic systems depend on the local soils 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 lost 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 or party is not authorized, nor will it confer any legal right whatsoever. 5. DSD SIGNATURE �I t/'� Approved for 3 bedrooms. Disapproved. Conditional approval for Attachments: COSA Checklist Septic System Advisory Well Flow Advisory bedrooms, with the fllowing Arsenic Advisory Maintenance Agreements OF4 ....• 0.00.0 Supplemental Engineer's Report Nit a e Adv iso Other By. (R". 11AS) Original Certificate Date: Municipality of Anchorage \� Development Services Department Building Safety Division On -Site Water 8 Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: ROLLING HILLS ESTATES: BLOCK A, LOT 6 Parcel ID: 011 A. WELL DATA *INFO PER 1960 'INSPECTION REPORT Well type PRIVATE If A, B. or C provide PWSID# N A Well Log (YIN) *NO Date completed *7/11/1960 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES Total depth •87 ft. Cased to •76 ft. FROM WELL LOG Date of test *7/11/1960 Static water level •75 ft. Well production UNKNOWN 9.p -m. Casing height (above ground) 12+ in. AT INSPECTION 9/18/2008 78. ft. 6.0` g.p.m. WATER SAMPLE RESULTS: Coliform O colonies/100 mi. Nitrate()—. 1-0 mg./L. Other bacteria colonies/100 ml. Arsenic: NO ug./L. Date of sample: 9/18/2008 Collected by: GEG Ltd. B. SEPTICIHOLDING TANK DATA 14INFO PER 1960 INSPECTION REPORT. **IN CRAWLSPACE. Tank Type/Material 'SEPTIC/STEEL Date Installed *7/11/1960 Tank size • 1000 gal. Number of Compartments *1 Cleanouts (YIN) YES Foundation cleanout (Y/N)••YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/9/2008 Pumper NORTHLAND PUMPING C. ABSORPTION FIELD DATA a ow EMSTING GRADLJ 1960 CRIB/1974 CRIB Date Installed 7/1960 - ••8/1974 Soil rating (g.p.d./ft'or ft9bdrm) UNKNOWN System type CRIB CRIB Length ' 8/15 ft. Width 8/15 ft. Gravel below pipe 6/UNKOWN ft, 1 Total depth 08.3/11.1 ft. Eff. absorption areas992/5002 T it2 Monitoring tube YES ''Depression over field NO Date of adequacy test •••9/18/2008 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test30 in. Water added 450 gal. 1 New depth41 in. Elapsed Time: 120 min. Final fluid depth -33 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - ••1974 PIT INSTALLED WITHOUT PERMIT, AND NOT INSPECTED AND APPROVED UNTIL 1979. INFORMATION ON 1974 PIT FROM 1986 C.O.S.A. •**TESTED 1974 CRIB ONLY D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N "Pump on" level at in. "Pump oft" leve High water alarm level at in. Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot •50'+ On adjacent lots 100'+ Absorption field on lot '50'+/100'+ On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 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: 1 1960 CRIB 1974 CRIB Property line 10'+/10'+ Building foundation 10'+/UNKNOWN Water main N/A Water service line 10'+/10'+ Surface water 100'+/100'+ Driveway, parking/vehicle storage 10'+ 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+/100'+ F. COMMENTS 'WELL 50'+ FROM 1960 CRIB AND TANK PER OLD REGULATIONS. WELL 100'+ FROM 1974 CRIB. 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 l'V // 4) COSA Fee Date of Payment o b /o Receipt Number 5/ YL0 (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number | mmmN Z 0p \ \ . e0000E: .513. co � Ul —____VIOLET DRIVE.__ Z2 R#eN in'&e ReR§2U3MUM Nwi R2 2q& - � { rn § N # ® \ \ - �r ■.,` � � � ! » 0-(3,2'30-E I49 m / Ul —____VIOLET DRIVE.__ Z2 R#eN in'&e ReR§2U3MUM Nwi R2 2q& - � { rn § N MUNICIPALITY OF ANCHORAGE O Department of Health &Human Services � DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. p /I/1- erlrz�- zC HAA B `R� - 0,-'7z L1 LI 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) "7- G &e, -,e A ,ZocuA i/at ear. T01) ;;ei4J sc'd 3 Location (address or directions) 7y38' ✓/O[ F &... . (b) Property owner 6VoL aM� Telephone: (home) Business ZYj "�8to3 Mailing Address 7238' y'iotGT 24. Na Ae ffCOZ- (c) Lending Institution &,JkIJ4WJ Telephone Mailing Address (d) Real Estate Company and Agent Address Telephone (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: AjGf tdla, Pieaz UO. 2. TYPE OF RESIDENCE Single-Family)e Number of bedrooms 3 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72.021(Rm.?/U) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION 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 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 / �Gf �Tellephone Z7 9 �sssj Address /Y /L eJ 33d- IjVe l he f psa 3 Date Z, -/3 "re ur HL .0 �?'497" .. . in •�ea� .. ` (neer G ' ROY c. RE!D, JR: may" CE -22 51 ' o �a a '••.......••'�c^b�� 6. DHHS APPROVAL ` ��// // Approved for 3 bsdrooms by r '� Date �lV fir— f ,l Approved7XDisapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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 oranalyze data before a certificate is issued. The Municipality of Anchorage is not responsible forerrors oromissions In the professional engineer's work. 72-025 (Rm.7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) % alth Authority Approval (HAA) • .r pnCHO=A —. CKLIST - FEBRUARY 1984 N,uNtGtl •Es Ctvt- �� M-4744 envt,.� Legal Description: "7T6 Bt,C A ;aLLjJ, 4,as EST � ,. • 1 � l9aa 7y,./ Z19"'h1 re -t 3 A. WELL DATA Well Classification RECEJ\J��VA-TE If A, B, C, D.E.C. Approved (Y/N) WA Well Log Present (Y© Date Completed gAo�e ndJ - PPZ /970 Yield � �• 7 6',411 Total Depth�Cased to 416 t Depth of Grouting i Static Water Level 77 Pump Set At Casing Height Above Ground �� Sanitary Seal on Casing�N) Electrical Wiring in Condui (Y N) Depression Around Wellhead (Y© SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot fob 'O "X*J^ ; On Adjoining Lots ley t To Nearest Edge of Absorption Field on Lot /03 • T JZAJANE�On Adjoining Lots Zoe It To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Manhole N To Nearest Sewer Service Line on Lot yS It, Water Sample Collected by A -ef A' /EN ; Date J_ Water Sample Test Results a/te ;r- -'6 .i1/7PAT� -9— Comments ® d"l- 1?^J 74157' /Z -S-Br "en W -1/-F6 /moi - B. SEPTIC/HOLDING TANK DATA Date InstallePWE /94eSize ZOD'D 61 No. of Compartments Standpipes ON) Air -tight Caps ON) Foundation Cleanout (Y© Depression over Tank (YeN Date Last Pumped %-lG W /f1f74eS Pumping/Maintenance Contact on File (Y/N) ��� ; for Holding Tank High -Water Alarm.(Y/N) AA � Temporary Holding Tank Permit (Y/N) A A .b SEPARATIONDISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Wef If • 46 `"bhou u : ei y r T B ildin Fo ndation /G JI fdeh eLEAA)e 7' To Property Line To Water Main/Service Line g i To Disposal Field S f To Stream, Pond, Lake or Major Drainage Course /VV *" Comments dA fee' kt '/�"�' />M nms (nw. ?/W FMnI Page 1 of 2 46 BA 7etux.K Attf eST C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata uA✓K11e" w Type of System Design Z C,f/BS @Date Installed ''0/- /es- /960 'OX -/97V � dd/ - 8 � Wz- - /S � � � r � � ength of Field � �,z " • &Vidth of Field /- 8 + 1 /5 �epth of Field / '(e , Gravel Bed Thickness uA)ieJewJ Square Feet of Absortion Area ® G9Z Statndpipes Present®/N) Depression over Field (Y&1 Date of Last Adequacy Test Results of Last Adequacy Test—MMY�E SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well /03' jk-eN Y7,WJe1&_ To Property Line To Building Foundation S3 'fAiH sT/PJb/iVE To Existing or Abandoned System on Lot ---- /0 �a ; On Adjoining Lots /o -r- To rTo Water Main/Service Line /0 f To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course - /Or �f To Driveway, Parking Area, or Vehicle Storage Area ' /0 r fl Comments a F%,4 t1 - /1"g /14A - D. LIFT STATION Size in Gallon "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "Check Permitted Bedroom Rating Against HAA Request" certify that I have checked, v ified, or conformed to all MOA and HAA guid!4wkil inspection. Signed ,.,�Q- Company �f 1W Date q Aw * 49tH /Z -/j 0096.60". ...., on the date of this ..;y.:. Wngineer's Seat or MOA No. O f. .Z/1.:.:�'... G REA JR. Receipt No. D S - Q-3 / Date of Payment Amount: $ /70-M 7228 (Rev. 7/88) Beck ' ,:`/CE -2251 �, Receipt No. QilkJX Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 99501 26e-4720 SOILS LOG — PERCOLATION TEST SOILS LOG D PERCOLATION TEST PERFORMED FOR: fl e'ro U 131 L k DATE PERFORMED: 4 6 LEGAL DESCRIPTION:ILS'_/ r> Pr DEPTH •-rpi, Sor 1 Frost 1 MI SLS; MS; 5a _ Ced Brm F.: e 3 5+1 Molst 4 GrAy Fi-e 5 M occ. C r• 5 140:s't 6 ' s:�r►�s7 SAS. e MI 6ec, Cr Lwyer g _10- 11 SLOPE WAS GROUND WATER N ENCOUNTERED? o 12 M! c^d'Er I1 Layers 5M ! Ors F inC \- IF YES. AT WHAT DEPTH? 13 S i Sa oa�+oota r �.f 14- .. .. ,.'A A Is 16 M► 17 18 19 MI 20 COMMENTS_ lICIL N,f flT:'Oi: ,'• CZ -4369 'l�1_y�•••OH•• IIrcom tn9 ..mac We-tierT Di SITE PLAN �. Gross Net Depth to Net t(•!h!jd'ng Date Time Time Water Drop • r 4. f 4 .Z PERCOLATION RATE Af nL 'Tic-fij _(minuteslinah) ' _.. —.TEST RUN BETWEEN FT AND FT e r 1 -1, f ,n fed) c PERFORMED BY:A M—r > CERTIFIED BY: .yI M»�_�•Ll� DATE: 41111,e(,5'o;/s -test & ref✓e5t of DOPS •Per-Venlfl A✓fLertfy f1fP✓o✓n� _xnne�an• MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPRbVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date -% A "� 1£6 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) L. C. 13 A AN Fsi71« -5'3 7-1 ;t.v eqttj Location (address or directions) 77-238 V,'olei- Pic, (b) Applicant Name Heca)a( '86ck Telephone:Home 243-1663 Business Applicant Address __ , 4 L ✓e - (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ®; Buyer ❑ ; Other 11 (explain); (d) Lending Institution i-iAt L ZV4c✓ Ct=,r Telephone -�2 74/ (e) Real Estate Company and Agent • 421 zf"z? n Address Telephone (f) Mail the HAA to the following address: p/u - - 79n Lk);) 2. TYPE OF RESIDENCE Single -Family 0 Multi -Family ❑ Other Number of Bedrooms __3_#_ 3. WATER SUPPLY Individual Well Q Community ❑ Public ❑ Note: If 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 ❑ Community ❑ Holding Tank ❑ Note: It communitywell system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 ' 72-025 411,841 n 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation dale shown below, I verify that 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 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 /lh/a•✓ t Lary L - �• Iter_ Telephone .34-4- +711 Address Date WATER WELL NOTE: This Health Authority Approval inspection merely certifies that the subject water well produced 150 gallons per bedroom or more on the date of testing and that certified laboratory tests showed no presence of coliform bacteria in a sample of that 4t) water. No warantee 'or certification is expressed or implied ^�,f,� • A '•.•tS> ©n concerning the long term adequacy or safety of the water supply. ! '• _-7••,f0'� ON-SITE SEWAGE DISPOSAL SYtTEM NOTE: This Health Authority Approval r'•' ••• inspection merely certifies that the subject on-site sewage disposal C ;S. •.r4.••..•;••• system accepted at least 150 gallons of water per bedroom on the date of testing as determined by methods approved by the Municipality 0 3,r•• CE -4067 of Anchorage Department of Health and Human Services. No warantee C�4�-••• •••••••,�;:4 or certification is expressed or implied concerning the', long term Op'`l;0ir;_;JT`po adequacy of the on-site sewage disposal system.' Construction data Va00000 reported on buried system components is from MOA files and was not verified during this inspection. 6. DHEP APPROV L Approved for bedrooms by)49" Approved �Yi� Disapproved Conditional _ Terms of Conditional Approval AR CAUTION Date_(` C ' The Muncipalily 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 satisfycertain federal and stale 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 engineers work. Page 2 of 2 MUNICIPALITY OF ANCHORAG: DEPT. OF HEALTH 6 ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) APR 14 CHECKLIST -FEBRUARY 1984 RE�E�E� 284-4720 VV Legal Description: �- r 13, A ; go 11,51 Hi pS Es la les es S3 •Tlx N 24V✓ A. WELL DATA Well Classification R ? S • It A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Yield F✓ f�� Z <Pr ) Total Depth 7 87 r -K Cased to ? -7& Depth of Grouting Or, k.. ew n Static Water Level t 611L"D . Pump Set At '45. 1 r, y Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) )nslb slold&l %ver Depression Around Wellhead (Y/N) .14 Separation Distances from Well i To Septic/Holding Tank on Lot 61 ; On Adjoining Lots )cn r 4 - To To Nearest Edge of Absorption Field on Lot 102r ; On Adjoining Lots > 1 cc To Nearest Public Sewer Line N4 To Nearest Public Sewer i Cleanout/Manhole To Nearest Sewer Service Line on Lot So Water Sample Collected by Date Water Sample Test Results - S Comments -K Err=�19Cit) lns�r[ l lcv Y[r r t B. SEPTIC/HOLDING TANK DATA Date Installed ire I .960 Size 10102 No. of Compartments --- I Standpipe (Y/N) % Air -tight Cap$ (Y/N) Foundation Cleanout (Y/N) k (� 2fe ) to✓ it l Depression over Tank (Y/N) Date Last Pumped 1 r ►� fEl Pumping/Maintenance Contract on File (Y/N) A) 1, ; for Holding Tank High -Water Alarm (Y/N) _1• /A Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well 6 1 To Building Foundation > to r To Property Line > To Disposal Field > t o To Water Main/Service Line 4G * To Stream, Pond. Lake, or Major Drainage Course Comments T[lnL ;..-re rw.�-ylen -/-re t9L-o IrsA� ref2ort; S-ee endo -s -c( Flee +u 5-1-c.-10 1,1,1 . + Page 1 of 2 C� 72-02(,111,134)/ C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 0/ k.`e.., v. Type o1 System Design 12+5 Date Installed It I Fre 1960- #2 -Avn 1974 t Length of Field Width of Field 4 1 RxF ---i ' # 2 - 15X (: f Depth of Field -" �7 �• / , 1" 2 - 9 �t Gravel Bed Thickness /2- krlwn Square Feet of Absorption Area -,T= t Standpipes Present (Y/N) i Depression over Field (Y/N) li Date of Last Adequacy Test -¢ 1 Xq6 Results of Last Adequacy Test =` .= o 2 :34>u- Separation Distance from Absorption Field: To Water -Supply Well hC 2 To Property Line rG 4 - To Building Foundation > 40 To Existing or Abandoned System on r Lot 1 S t ; On Adjoining Lots ti 1A To Water Main/Service Line i To Cutbank (it present) e<%1A To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area e) i' ('t.2 Comments �2/bwnefi_Uefel Pel'm1� b.. Hill E)(c. Ar..,,ted 1,., mom �e1+.9 � 7 9 ns..p le1 gni 7,—,<'f Hct I, T I I's .e NO f) rsq uee, t Fn 4�¢�PL /.isua✓f t ,/ eco—menevf toe",oer -JA.,6µt P{s Le Sur:. ed or ir..Ulect � At-LucL`ed. e.,tt1, Ha Oa in the +tvre, D. LIFT STATION N/A 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 •' Icertify tha v c c d,v I' d, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ,�� Date I SAG Company Receipt No. --1-77S5 Date of Payment _4_Lq-_ Amount: S MOA No. Page 2 of 2� 72-026111,84) nmwvap NUL N,W9 -CSN[ Q CE -436? - MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. O P-PLTH & 825 LStreet • Anchorage, Alaska 99501 ENVIRON:.'.[NTAL ii:;:LCT10N rvAoENVIRONMENTAL ENGINEERING DIVISION MAR 2 7 1979 Telephone 264.4720 6. TYPE OF RESIDENCE '. pp (' REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWERlEACEWED ❑ One ❑ Four ❑ Other DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER ❑ MULTIPLE FAMILY PHONE - Harold L. F, Carol`A:'Black - 243-1863 MAILING ADDRESS ❑ COMMUNITY 7238 Violet PL: Anchorage, Alaska 99502 ❑ PUBLIC UTILITY PROPERTY RESIDENT (If different from above) 8. SEWAGE DISPOSAL SYSTEM PHONE Same _ "If individual/on-site, give installation date Unlch01sT1' 2. BUYER .. _. PHONE- -WA ; MAILING ADDRESS 3. LENDING INSTITUTION - PHONE First Federal Savin a f-Loan`Association of'Anchora1e 274-6S65' MAILING ADDRESS P.O. Box 4-2200 Anchors e' Alaska 99S09 4. 9�TMAM-- PHONE ATTN: Martin J. Stuehr MAILING ADDRESS 5. LEGAL DESCRIPTION Lot 6, Block A Rolling Hills Estate Anchorage, Alaska STREET LOCATION .. .. 7238 Violet Place 'Anchors a Alaska 6. TYPE OF RESIDENCE '. NUMBER OF BEDROOMS ❑ One ❑ Four ❑ Other Q SINGLE FAMILY ❑ Two ❑ Five _ ❑ MULTIPLE FAMILY ❑ Three ❑ Six 7. WATER SUPPLY - El INDIVIDUAL' ' ATTACH WELL LOG. A well log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM - Q INDIVIDUAUON-SITE** _ "If individual/on-site, give installation date Unlch01sT1' If system is over two (2) years old an adequacy test is required ❑ PUBLIC UTILITY by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY INSPECTION APPOINTMENTS OATS HECEIVEU TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE _] SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER of BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ T1.10 ❑ FOUR ❑ Six 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL , DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE ❑PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ❑Septic Tank or ❑Holding Tank Size: If Tank is homemade give dimensions: SOILS RATING - TYPEOFTANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WCLLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS -.. Z> --APPROVED FOR BEDROOMS. ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY (Titl LEGAL DESCRIPTION 72010 (Rev. 3178) / ` l -- " GREATER ANV!CRA =- AREA NrN,rn)ru X�y11 /nD3Partmrnt of Environmental N-11 ity 35C?Ooo v Anch:-ag..mY e, Ala;.. l•a 9<)c!7 270-'3f,? ) \ } 5� Date Receive? u T- �/ o� Q Time of Inspection Date of Irsnection v Pnr+i,ccT cpo A:)[ q0'!0. OF \1 Ck INDPJIDUAL SE:`i ? S ;:ATEE FACILITIES 1. Aoproval Requested 9•i: //IQ LR4UV) Y/� "/#Z:!; h, Address: 2. 3. Property Owner: Legal Description: Phony• 3 `xa97-,c7ia/� 4. Location:_ 5. Tvpe of Facility to he Irscected: Numher of Bedrooms: 6. Well Data: A. Tvne B. Depth C. Construction D. 9acterial Analysis 7. Sewage Disiosal System: A. Installed 9. Installer C. Septic Tank: 1. Size _ 2. Manufacturer D. Seepage Pit: 1. Size 2. Material_ E. Disposal Field: Total lernth of Lines B. Distances: A. Well To: Septic Tank Absorption Area Sewer Lines dearest Lo! 'AnnOther Contamination B. Foundation to SAptie Tank r Absorntinn Area C. Absorotion Area to Nearest Lot fine Request for Anvroval of ' ^ vfdual Sewer F. Water Fantlitl,'^ -Page Two 9. Comments: _ d✓� _ten 7114_, Annroved Dfsaonroved '?? t e Ar ro al Va;id for One Year Frn� ba',e 3f mod Greater Anchnra m Arei Inro+mh. Dera'rtrert rf E^cf-n- .gin tal Quality �Tq-^,•:ane! 0;r SYSTEV I certify that the infomation contxine-! in this req+tast for ancroval to be a true and accurate representW on of the suilect server ani water facilities located at: S19ne,1 OBte