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HomeMy WebLinkAboutPARADISE VALLEY BLK 5 LT 7 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 hftp://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP231356 Work Type: SepticTank Upgrade Tax Code Number: 02041201000 Site Legal Address: PARADISE VALLEY BLK 5 LT 7 G:3538 Site Mailing Address: 18257 NORWAY DR, Anchorage Owner: ROBERTS BRIAN G Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: Effective Date Expiration Date: Lot Size in Sq Ft: Total Bedrooms: ala c .S 9r ■ f. Departnient 10/26/2023 10/25/2024 20956 ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: Locate the trenches to ensure that the required separations are met. S C,�� +o z� S Date: Issued By: Date:D 7— Z 3 Municipality of Anchorage P.O. Box 196650 • 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 o Fax (907) 343-7997 http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV231053 COSA#: Permit#:OSP231356 PID#: 020-412-01 Legal Description: PARADISE VALLEY BLK 5 LT 7 Engineer: Pannone Engineering Services Your request for a waiver of the required 100 feet horizontal separation from the septic tank to the private well has been approved. The approved separation distance is 96.0 feet. This waiver approval applies to the proposed septic tank only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. ............................................... ■ ............................. ■ 1 Waiver is Granted: X Waiver is not Granted: Date: ,D�Z6 �23 Approved by: Name of Reviewer **** VARIANCE/WAIVER REVIEW **** Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-412-01 Property owner(s) Brian Roberts Day phone Mailing address 18257 Norway Drive Anchorage, AK Site address same Legal description (Sub'd., Block & Lot) Paradise Valley B5 L7 Legal description (Township, Range & Section) Lot Size 20,956 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (N all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑x (w/wo ADU) Septic Tank ❑x Upgrade ❑x Duplex ElHolding (D) Tank ❑ Renewal ElMultiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Septic Tank to Private Well Distance: 96' I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. ST2,{> (Signature of property owner or authorized agent) Permit/Rush Fees: A2 --Z5- Waiver Fees: -0 // 9 0 Date of Payment: /0116ZZ3 Date of Payment: - She Receipt Number: ���lrg, (G Receipt Number: Permit No. Waiver No. 05 U21, 105 3 Permit App_'- : . _..:c Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Mailing: P.O. Box 1807 Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 17 October 2023 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska Subject: Paradis Valley B5 L7 Septic System Upgrade Permit Request This is a design narrative for a permit to install a 1000-gallon septic tank to replace an existing 1000-gallon septic tank to be issued for this property. Currently the lot is developed. The proposed replacement will be connected to the existing drain fields. This lot and the surrounding lots are served by private wells. There are currently no wells within 100’ of this upgrade. The existing septic tank is located within the 100-foot protective radius of the private well on the property. A waiver was granted by the department in 1985 to a distance of 96’. The locations of the existing drain fields prevent the tank from being moved outside the well radius without disturbing the drain fields. For this reason, we are requesting that the department renew the previously approved waiver for the new installation. Please see attached waiver request. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5’+ from any property line. 5’+ from any deck/stair support. 10’+ from building foundation. 10’+ from any water line. 100’+ from any surface water. 96’ from any private wells. 200’+ from any public wells. The proposed installation will not affect the future development of this or the surrounding lots. If you have any questions or concerns, please contact me at (907) 745-8200. Sincerely, SRP Steven R. Pannone, PE, F. ASCE Owner/Civil Engineer Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231356, Deb Wockenfuss, 10/26/23 Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com Mailing: P.O. Box 1807, Palmer, AK 99645 Telephone: (907) 745-8200 FAX: (907) 745-8201 Municipality of Anchorage Development Services Department On-Site Water & Wastewater Program 4700 Elmore Road Anchorage, Alaska Subject: Paradise Valley B5 L7 Septic Tank to Private Well Waiver Request Ladies and Gentlemen: I am writing to request a separation distance waiver down to 96 feet, between the existing private well on the subject property and the proposed septic tank on the same lot. The existing septic tank is located within the 100-foot protective radius of the private well on the property. A waiver was granted by the department in 1985 to a distance of 96’. The locations of the existing drain fields prevent the tank from being moved outside the well radius without disturbing the drain fields. For this reason, we are requesting that the department renew the previously approved waiver for the new installation. The groundwater in the area generally flows from north to south across the property. The well is located at a higher elevation than the proposed septic tank installation. If the septic tank were to fail, all percolating and/or overflowing effluent will travel away from the well casing. A search of the nitrate values on this and surrounding properties shows no values over the EPA suggested limits. The historic Nitrate value for the subject property is 0.1 mg/L The worst-case scenario is the separation distance between the absorption field and the private well as outlined under 18 AAC 80.020 and 18 AAC 72.021(a), I have calculated the following points: Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231356, Deb Wockenfuss, 10/26/23 Paradise Valley, Block 5, Lot 7 Septic Tank to Well: Distance from sewer system bottom to groundwater 5.11 Soil sorption below sewage system 4.68 Soil permeability below the system 2.00 Water table gradient 2.00 Horizontal separation 2.84 Total Points 16.63 The sum of the above values could equate to the following conditions: Almost sure to be free from any form of contamination from household sewage. It is the opinion of this office that granting this waiver does not pose a risk to public health or the environment. Approving this waiver will not hinder the future development of the area. Please contact me if you have any comments or concerns. Sincerely, SRP Steven R. Pannone, PE, F. ASCE Owner/Civil Engineer 16 October 2023 FOR CONSTRUCTION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231356, Deb Wockenfuss, 10/26/23 FOR CONSTRUCTION Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP231356, Deb Wockenfuss, 10/26/23 Municipality of Anchorage Page ' 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: ,~'~"~'~)~1"~I PID Number: O ~O ~ ~1~-- O Name: ~-~O~~ ~ ~[~ Wastewater System: ~ New ~Upgrade Address: I~*~ "~NO ~A~ D~. ABSORPTION FIELD Phone: ~ No. of Bedrooms:  eepTrench ~ Shallow Trench ~Bed ~ Mound ~Other Soil Rating:~ Total Depth f[om o~al grade: LEGAL DESCRIPTION O,~ ~o/sq, ~. Lot: Block: ~ Subdiv~ion: Depth to pipe bottom from ori inal grade: Gravel depth beneath pipe Township: Range: Section: Fill added abov~ ~r~inal grade: GraveL length: ~ ~ Numberoflines: Dislance~enli .... WELL: / ~ Upgrade Gravel width: ~ Ft, J Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total~sorpt;on area: Pipe material: ~t,V~ I?~ ~. I~' ~. ~o0.O s~.~. 3~ Driller: Date Drilled: Static Water Level: ,nstaller:~ ~ Ft.~ ~ ~ --~. Date iostalled:./~ Yield: Pump Set at: Casing Height Above Ground: GPM ~*~m ~,. ~. TANK SEPARATION DISTANCES ~ Septic ~ Holding ~ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: Fro~ Tank Field Sla[~on Tank ;ewer Lines Weft ~t ~ -- -- -- Material: ~, Number of Compartments: Surface _ - LIFT STATION Water ~ ~ Line Foundation ~lI' I~} -- "Pump on" level at: "Pump off" level at: High water alarm at: CurtainDrain ~ - ~ ~ -- Pump Make & Mo,.d Electrical Inspections performed by: Remarks: BENCH MARK ~ ~"' ~ ~0.~, Location and Description: Inspections performed by: ~.'~ Dates: 1st ~o/'7 "' Department of Health and Human Services approval '~' Reviewed and approved by: /~ Date:. ~ 72-013 (Rev 9/91) MOA 25 ~ ~........ ................. ., ........... ~1 : ~ Well 279-3916 PE£klIT # sw970217 TOBBEN SPUNKLAND P.E. 203 W 15TH. AVENUE ANCH. AK. 99501 PARADISE VALLEY, LOT 7, BLOCK 5 18257 NO£WA Y DRIVE BR/AN ROBERTS SEPTIC ,SYSTEW AS BUILT I DATE: AUG. 4 1997 SHEET: 2/3 GRID: 3538 PDVOSO7~,DW5 PIP # 020-412-01 EX/STING SEPTIC TANK EXISTING 5-WIDE ZD 200 FLO~/ DIVERTER NonJi, ot' Monitor Cleon LTut C{eon W/dm 60' Lon9 Deep Se~e~ foci< Cover BOTH ENDS / 90.5 ~ BOTH ENDS N~] SCALE FLOW SPLITTER 1000 S£PUC TANK BENCH MARK. PdST FND. ASSUMED ELEV, H£,O0 TB~BEN SPURKLAND P,E, 203 W15th ave Anchora9e ak 99501 L [7 T 7 ?L Z~CX 5 PA£ADISE BRIAN R~TBERTS 18257 NORWAY ~RIVE VALLEY SEPTIC SYSTEM SCHMATIC DATE;. AUG < SHEET, 3/3 GRID~ 3535 PERMIT // SW970217 PID // 020-4t2-01 PVDO5OT$.DWG PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW970217 DESIGN ENGINEER:TOBBEN SPURKLAND, P.E. OWNER NAME:ROBERTS BRIAN G & COLLEEN K OWNER ADDRESS:lB257 NORWAY DRIVE ANCHOEAGE, AK 99516 DATE ISSUED: 7/28/97 EXPIRATION DATE: 7/28/98 PARCEL ID:02041201 LEGAL DESCRIPTION: PARADISE VALLEY BLK 5 LT 7 LOT SIZE: 20956 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD 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 (18AACS0). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4%44 ( 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 BY: DATE: ISSUED BY: DATE: Rick Mystrom, Mayor Municipality of Anchorage Department of Health and Human Services 625 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 July 29, 1997 Tobben Spurkland, P.E. 203 West 15th Avenue #203 Anchorage, Alaska 99501 Subject: Waiver Request for Lot 7 Block 5 Paradise Valley Subdivision Waiver Request #WR970041, PID #020-412-01 Dear Mr. Spurkland: Your request for a waiver of the required 10 foot separation between an on-site wastewater disposal system and a lot line has been approved. The waived distance is 1 foot from the leachfield to the south property line. This approval applies to the existing on-site wastewater disposal system lot line separation only. Any future upgrade to the on-site wastewater disposal system will require all separations be met or another approval from this department. If there any further questions or concerns regarding this waiver, please call our office at 343-4744. Sincerely, Anthon~ Ki[~ Civil Engineer On-Site Services Program Roberts MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR~L~L~3~- PID~ /25~h~,~f~ HA# Date Received: Legal Description: Engineer: ~ Permit ~ ~[3.~c~'"~n.~%''] Applicant: Waiver Requested: Criteria: 1. Geology: Points: A. Water Table B. Soil Sorption C. Permeability Do Water Table Gradient E. Horizontal Separation TOTAL: ° Special Conditions: 3. Other: Waiver is Granted: V/ waiver is NOT Granted: List Conditions or Reasons for above: Da te: By: ~]~4~/~9~ /~ ',.. ~ Name of Reviewer ~-~ Rec #: C~D\~/ Amount: $ %%~,~ Date Paid: To S?L T KLAI 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907) 279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN PARADISE VALLEY, BLOCK 5 LOT 7 BRIAN ROBERTS Municipality of Anchorage Department of Health and Social Services 820 1 Street Anchorage, Alaska 99501 July 6, 1997 We are submitting an application for the upgrade of a septic system for this lot. The septic system failed an adequacy test and must be upgraded. This submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and pemolation tests of applicable testholes are also enclosed. The septic system design is based on the following: Bedrock at 13 fi. No groundwater Use Standard Trench Soil Rating. 11 min/in = 0.8 gal per sq.ft/day No. of Bedrooms 3 Required Area per Bedroom: 150/0.8 = 187.5 sq.ft. Total area required: 3 x 187.5 = 562.5 sq.ft Testhole depth 13 feet Bedrock Bottom Rock At 7 feet Top Rock At 2 feet Rock Depth 5 feet Total Trench Length 562.5 / 10 = 56 ft. SYSTEM CONFIGURATION STANDARD TRENCH TOTAL LENGTH 60 FT TOTAL WIDTH 2 FT TOTAL DEPTH 7 FT ROCK DEPTH 5 FT COVER 3 FT CHECK INTEGRITY OF EXIST1NG TANK Due to the limited space available caused by the location of the well, we request a lot line waiver to 1 foot, both for the existing drainfield and the proposed, and a waiver from the required separation distance between drain fields. Approximately 15 linear feet of the proposed drainfield will be 7 feet more or less away from the existing 5-wide. The proposed drainfield will be located below the existing field, and we do not expect any undue influence on the soil from the present system, which will be pumped prior to the proposed work. The installation of this septic system will not prevent wells from being 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. N TOBBEN SPURKLAND P.E. 205 W 157H. AVENUE ANCH. AK. 99501 (907) 279-5916 PARADISE VALLEY, LOT %, BLOCK 5 18257 NORWAY DRIVE Bt?lAN ROBERTS [ SEPTIC SYSTEW DESIGN DATE: JULY 6, 1997 SHEET: 1/$ ON/D: $558 PERMIT # PIz9 # 020-412-01 P~gVO$$71,Dk/5 N 125 ['~"~ ~'¢~" INSTALL ~' PA£ALLEL l'O ?L 6OFT TD 7 FT £OCK 5 FT Well ~AS WAX SLOPE 205:% £XIST. >~,]~, D.F TOBBEN SPURKLAND P.E. 205 W 157H. AVENUE ANCH. AK. 99501 (907) 279-5916 P3R3DIS£ V3LLEY, LOT ?, BLOCK 5 15257 NORWAY DRIVE BRIAN ROBERTS SEPTIC SYSTE/vt DES/ON DATE: JULY 6, 1997 SHEED 2/5 GRID: 5558 PERMIT # PIP # 020-412-01 PDVOSO72,P~6 EX/STING SEPTIC TANK EXISTING 5-1OLDE ZD 200 FLOI¢ DIVENTE£ Noniton Noni~or Cleon [Tut Cleon LTu INSTALL NEW TRENCH £' W/de 60' Lon9 7' Peep 5' Smwer rock 3' Cover ND SCALE ~,o~o~,o°o~,Oo ND SCALE ]000 SEPTIC TANK EXISTING CHECK INTEG£1TY £ENCHNA£~ ASSUME~ ELEK iO~OO TOBBEN SPURKLAND P,E, 803 WlSth Ave Anchorcge Ak 99501 VALLEY SEPTIC SYSTEM SCHMATIC ~TE: JULY ~ ]997 SHEET, 3/3 GRI~, 3538 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19- 20- DISCLAIMFR? Groundwater Past and future presence trom these obserYar~.~s. DATE PERFORMED: Township, Range, Section: SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? S L IF YES, AT WHAT O DEPTH? p E Depth to Water Afte_r! Moniloring? ~:1~ Date: Reading Date Gross Net Depth to Net Time Time Water Drop ~,/~. i,~., ~ - PERCOLATION RATE // (minutes/inch} PERC HOLE DIAMETER ~ II TESTRUNBETWEEN ~ FTAND 5,~FT cnnditinns indicated a~efo~ thedates sh¢~n only. and/or depth of groundwater can not be predicted PERFORMED BY: I ~- CERTIFY T~HA~ THIS TEST WAS PERFORMED IN '> DATE: : ACCORDANCE W,T. ALL ~TATE AND MUN,C,PAL GU,D~L,,~ES ,,~ EFFECT ON TH,S DAT~. 72-008 (Rev. 4/85} MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROT~;_ rlON ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME MAI LING ADDRESS S~r~ go-c~o~loP EGAL DESCRIPTION LOCATION J Well Absorption area ~ ~ Manufact~er I m [Lq. capacty n~a onsl .,, /OO~ ~ ............. : i ~ I IWell ~=1 D~STANC~TO: I ~ ~ No. of lines Length of each line ~ ~ I Top of tile to finish grade . ~ I Length !Width < ~ I Type of crib Crib diameter ~ I .......... ~- Building foundation I DISTANCE TO: I0 ~ Inside length Dwelling Foundation Depth Crib depth Driller Sewer line Total length of lines Material beneath tile Dwelli,~5_I / Materi~.//~_ / W dth OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER REMARKS Material Nearest lot line Trench wid~ C~ inches LLHONE [~/~EW ~-3[~ ~ E~UPGRADE NO. OFBEDROOMS 3 PERMIT NO. No. of compartments Liquid depth PERMIT NO. Liquid capacity in gallons PERMIT NO. Distance bet~7~ lines Total effective absorption area · /~ inches PERMIT NO. Total effective absorption area Building foundation Nearest lot line Distance to lot line PERMIT.NO. Absorption area(s) Septic tank APPROVED DATE LEGAL E:,EF'FIRT?ENT ~lHERLTH R1`',tD ENVIREd'-4ME1`'ITFtL '~OTECTIL-IN ,._....__.r~. 825 "L'' FF':EET.' FtNC:HORFIGE.' RI'::.'. '--=t'956. : /~;F/'/ F'ER'i'dIT [40. ':' ""''--'--'='¢' . -- ':': "'"';' ' --'~' · ,::,__".t':'l..'~O ':' [::'RTE uF-I ....LIE tb. IL F f :+:*:+: WHF. 1`.411`,t.., - [;,IJE TI_-i CHRNGING REQ_IF.'EMENTS THIS F'RINTOLT I"IR"r' Nf]T BE FIN E::':;FICT :+: I]OP"r' OF THE OF.:IGIONRL F'ERMIT :4-: - I-'- '-- '- 'D-' ~ ~" '~-:* -' "'"' '- HFFLI_.H1`,IT JIM Ft HLITTCI _,RH BOX ~.ld4i,_'P 9'3507 ._,e,_:'..-_',l~.~, LOCFIT 101`.4 LE=FiL L7 E,~, PRRFIE:,ISE VFILLE"r' LOT _,I~E '~9'~999 :=,QUPIRE FEET '- "- ' IS T"¢F'E F1F SOIL FIE:'=-iORBTIC;1`4 =,"r=TEi"l : E:'RFIINFIELE:' ' '-' ' '-- '= ..... "' '":'- MFI:=':iIMUM NUflBEF.. OF 6E[:F..UUM_, = ~: '-qr~IL RFiTING ,:'"-5L'~ FT,-'E,F. .... THE F.:EQUIRE[:, SIZE OF THE SOIL FIBS~]RF'TION S","STEM IS: [:. EF" TH= el. 5 L E ~-~ IS1-H= 59 iS R." R ",,.-" E L IE:, E F" TH = ) '- IS THE LE1`.4GTH [IHEI'.4.=ION THE LE1`-4GTH ,'IN FEET::, OF THE TRENCH OR DR. RI1`.4FIEL[:~. THE [:,EPTH OF Ft TR. ENCH OR PIT IS THE [:,ISTI=I1`.4CE BETWEEN THE SURFFiCE OF THE GROUN[:, FIN[:, THE BOTTOM ;DF THE E:=.,',CFiVFITION (IN FEET', THE T~'~:E~-4E:IH IL4 I [:,TH I.S._,.~ ~_--4~.i FEET. THE GRFiVEL [EFTH) ' IS THE I'"IINIi"IUM DEPTH OF GRF, IVEL BETWEE1`.4 THE OUTFFILL PIPE FiN[) 'I~HE BOTTOM FIF THE E'XCFiVFiTION (IN FE. ET). BFiCKFILLING OF FI1`.4'¢ S'¢STEi"li !..4ITHOUT FI1`.4FiL I1`.4.=,FEL. T!ON FiN[:, RPPR. OVFIL B"r' ]'HIS [:'EPFiRTMENT WILL 8E SUBJECT TO Ft~u_-,EL. UTI_1`.4 MI1`.4IHLII'"t [:,I_,THHuE BETWEE1`',I Fi t4ELL FI1`'4[:' FIN'¢ U1`.4-.=,ITE SEI.,.IFIGE [:'I'~P~]'=;FIL S"r'STEM IS :1. OO FEET FOR Fl PRI',/RTE WELL..~ OR :1.50 TO 20F~ FEET F]F.' FI PUE:LIC !.4ELL [:'EPE1`.4DING UPF;N-THE T"r'PE OF PLBLIC WELL MI1`.4IMUM [>I.=,TM1`.4_.E 'FF..'Oi'~t 1'3 PRIVFITE WELL TO Ft PRI~/FiTE SEWER LINE IS,=."~._, FEET FIND TO FI COMMUNIT"r' '"';EWEF..' LINE IS 75 FEET. glELL LOGS RRE RE6!UIRE[:' R1`.4[:' MJ=.TI '- BE" RETURNE[:' TO THE [:,EPRRTMENT WITHIN ]:0 OF THE WELL COMPLETION. OTHER RE6'~IF.'EMENTS MFI'T' RPPL"r' - SF'ECIFI¢:FITI01`4S FiND COHSTRUCTIEd'.4 [.IFiL~EFiII=, FiRE FIVFiILFtE:LE TO INSURE FF..FEF.' '~ ' ' II"4STRLLRTIO1`.4 t F:ERT I F'"¢ THFIT ±: I RM FFIMILIFIF.: WITH THE REg!UI'~EMEI'.4TS FOR UN-'_-,II'E~ '- 'SEWER. S FIN[:' WELLSH-~-'- SET FERTH B'¢ THE MU1`.4ICIPFILIT'¢ OF FI1`'4CHORFIGE. ~. I WILL INSTFiLL THE S'T'STEM 11''4 I=ICCOR[:'RI'.4CE WITH THE CODES. ]:: I UI'.4[:'ERSTFiN[:, THFIT THE ON-SITE SEWER S"r'STEM MR"r' I~'Ek.3JIF.'E ENLFIRGEMENT IF THE RESi[:,ENCE IS REMO[:'ELE[:' TO INCLU[:,E MORE THFIN ]: BEI.}ROOMS. S I GNED: FiF'PLICFiNT JIM Fi HUTTO ISSUE[::, .................................. [::, T E ..... iI',t=,FEL. TIUH HISTZF."T' - SEWEF.: i 0 SEI.,.IER 2 0 WELL iNSP 0 WELL LOG [::,RTE. 0 [:,RILLER PERMI ]" NO~ RPPL. ICRNT J'IM R HUTTO LOCFIT I ON DEPRRTMENT Off HERLTH RHD ENVIRONMENTRL ~*-~,..~TECTION~' 825 "L.'" STREET., RNCHORRGE., BK. 99591 264-4720 ( 85:05;~0 ) LEGRL L? B5 PRRRDISE VRLLEY LOT SIZE TYPE OF SOIL.. RBSORPTION SYSTEM IS: DRRINFIELD MFIXIMUM NUMBER OF BEDROOMS = ~ SOIL RFITING (SQ FT/BR)= tD5 ]'HE REQUIRED SIZE OF THE SOIL RBSORF'TION SYSTEM IS: D9~999 SQUFIRE FEET 4 'THE LENGTH DIMENSION IS THE LENGTH ,:lIN FEET) OF THE TRENCH OR DRFIINFIELD. THE DEPTH OF FI TRENCH OR PIT iS THE DISTFINCE BETWEEN THE SURFFICE OF THE GROUND FIND THE BOTTOM OF THE E',:'~CFI',,,'FITiON (IN FEET). THE GRFf,,,'EL DEPTH IS THE MINIMUM DEPTH OF' GRFIVEL BETHEEN THE OUTFFILL. PIPE FIND THE BOTTOM OF THE EXCFIVFITION (IN FEET). PERMIT FIPPL. tCFINT HFIS THE RESPONSIBILITY TO INFORM THIS DEPFIRTMENT DURING THE INSTFILLFITION INSPECTIONS OF RNY HELLS FIDJFICENT TO THIS PROPERTY FIND THE NUMBER OF RESIDENCES THFIT THE WELL HILL SERVE. BFICKFILLING OF FINY SYSTEM WITHOUT FINFIL INSPECTION FIND FIPPROVRL BY THIS DEPFIRTMENT WILL BE SUBJECT TO PROSECUTION. MtNIMLIM [:,ISTFINCE BETWEEN FI WELL FIND FINY ON-SITE SENRGE DISPOSFIL SYSTEM IS 100 FEET FOR FI PRIVRTE WELL OR 150 TO 200 FEET FROM FI PUBLIC HELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTFINCE FROM FI F'RIVFITE WELL TO FI PRI',,,'FITE SEWER LINE IS 25 FEET FIND TO FI COMMUNITY SEWER LINE IS 75 FEET. HELL LOGS FIRE REQUIRED FIND MUST BE RETURNED TO THE DEPFIRTMENT WITHIN ]:F~ DFIYS OF THE HELL COMPLETION. OTHER REQUIREMENTS MFIY FIPPLY. SPECIFICFITIONS FIND CONSTRUCTION DIFIGRFIMS FIRE FIVFIILFIBL. E TO INSURE PROPER INSTFILLFtTION. I CERTIFY THFIT 1: I BM FFIMILtBR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FIND NELL. S RS SET FORTH BY THE MUNICIPFILITY OF FINCHORFIGE. 2: i WILL. INSTRLL THE SYSTEM IN FICCORDFINCE WITH THE CODES. ~: I UNDERSTRND THRT THE ON-SITE SEWER SYSTEM MFIY REQUIRE ENLFIRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THRN ~ BEDROOMS. S I GNED: ................. = ...... RPPLiCBNT JIM R HUTTO [:,FITE ..... : ..... ~____ V4. 0 PQUGH 6-650 ANCHORAGE, AI_ASKA 99502.(}650 (907) 264-4111 r()A/~~ X~VO W~ I)i P/\t!TMENTO[: HI,a! !il ,',r, lt', ENVIRONMENTALI:'RO1EC]ION <Permit 9: 820349 <January 31, 1983 TO: Permit Applicant Subject: Lot 7 Block 5 Paradise Valley Subdivision A permit issued by this department for an individual well and/or on-site sewer system has expired as of December 31, 1982. Permits are issued on a calendar year basis, as stated on the permit, by authority of Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. If a private engineer inspected the installation of the on-site sewer system, please have them send us the as-builts for our files and documentation. If there are any further questions, please call this office at 264-4720. S incerel~ Robert C. Pratt, R.S. Acting Program Manager Sewer and Water Program RCP/ljw enc: Copy of Permit SWP/057 PER.H I 't" E:,EF'FiF;.:TP!ENT' 'x, , E., L.,f, '"'' "c t 4 Fdqr,_ ENV ! RCd:,tMEF,Ff'RL. 'i'fZ TEr":'T"[ IN 825 "L" 5 "r'F'EE'T RN :' H ':' !;."F 'iF' F:Lk:. 9S~501. ;2d;4-4720 FIF:'PL. t CFINT LOCFrr :[ LEGRL DFIL. E: E:'.'. E;CHRKtH.h'I NOF.:kiF!%' [)R t VE L7 B5 PFIRRDISE VFIL. LE~¢ E6:!.& I h'!LFICH LOT SiZE 20956 ',E;QIJFkRE FEET 'T"¢PE OF S:,OtL. FtE~SOF..'F'T'iOt',i S'¢S'!"EM tS: "f'RENC:H Mr:tX!MUM NUI'dBER OF [~EDROOI'"tS = 4 SOIl.... RFtT'ING <SQ F:'T,..'BR)= 195 THE REQUIRED SIZE OF THE SOIL RE~SOF.':PTIOt",! S"r'STEH IS: THE L. ENGTH DIMENSION IS THE LE.NC~i't"f'I '::IN F'EET> OF T'HE '!"RENCH OF.'.' DRRINI:::'!ELD. THE £:'EPTH Of:' R 'TF..'ENI:::H OR PIT IS THE DISTFINCE BETP.IEEN THE SURFFICE OF THE GROUND fiN[)THE BOTI"Cild C)F THE E:qC:R'¢FITION (IN FEET). T'HERE IS; NO SET P.!IE:,'T'FI FOR 'T'fZ,:ENCHES. THE GRR',/EL DEPTH IS; THE MINZML.fH DEPTH OF GI:;:.'F!VEL BETWEEN I"HE OI.JTI;:F-tLL. PIPE F:~NE) THE'; BO'T't"OM OF' 'THE EXC.r49'RTION <IF,! FEE:T). Pr..ERH!"F F!PPL. I CFff.,!T HF~S T'HE RESPONSiE~I L.!T'¢ TO INF'ORM 'TFi!S DEPIaR"FMENT DURING THE l NSTFiL_L..A/r !' ON I NSPEC:T! ONS OF' f'?N'T' I4ELLS:; FIDJF~CENT TO 'TH 15; PROPEF.'.T'¢ FIN[:' THE Ni..IHBER OF RES IDENC:ES THFF¥' 'T'HE I.,.!ELL P.IiLJ... S. ER',/E. ................. T' il..ql C') BFK:.'-'KF' ILL. i NG OF' RN:r' S"/STEM I.,.t DEF'FIRTMENT P.!!LL BE SL!B,!ECT "FO PROSECUi"I©N. MIN!HUH D!STRNC:E E:ETWE:EN R WEL..L. RND RN? O!',!-SITE SEWRGE [:,ISPOSFIL S'.?S'I"EH IS i00 FEET FOR F! F'RI',,,'F::ITE: t.4EL. L. OR t. 50 ]"O ~.::_'O0 FEET FROM F:! PLJE.-'LIC: !.,.!ELL. DEF'ENDINC:f UF'ON THE T~¢PE OF PL.tB!._IC WELl. .... MINtHL!M [:,iSTFtNC:E FROM R F'RI',/FYf'E WE::LL TO F'~ PF.:IVF:ITE S-EWER L. INE I:.:]; 25 F'EET FIND TO Fi COHMUNIT'Y L:i;E!.,.!EFR L. INE I5; 75 FEET. NEL. L LOGS, FIRE REQUIRED FIN[)i"iUST BE F.:ETUf;.:NE[:, TO 'THE [:,EF'IaRT'MENT WITHIN Z.':O OF THE NELL. COMPLE'T'ZON. OTf4ER F,~:E[-:!UIREHENTS MFt"r' FIPPL."r'. SPECiFIC.'R'TZONL:~; F!I",ID CONSTRUCTiOI',I DIF:IGRRI"!S FIRE F::i'v'F~ Z I...F!BL.E TO I NSLff;.':E F'ROPER Z NSTFILLFFF I ON. I C'ERTIF? THRT ::L: ! FtM F'FtMIL. IFIR i4!Tf4 THE REQL.tlREMENT:S FC)R ON-SITE SEWEFi:S:; RN[:' FIEL. L.S RS SE'T' FORTH 8~'r' THE MUN I C I F'F!L Z T'¢ OF:' FINC':HORFiC'~E. 2: t P.!ILL. It'-,!STF~;LL 'THE S%'::5'l"Ef'! ltq FiC::CORDFINCE P. fi't"H THE CCE)ES;. :Z.':: t UN[:,EFd.S'T'FtN,'.') THP,"t" THE ON-SITE SIEt4ER S'¢S:;TEM MFI? RE[::!UIRE ENLI:::IRGEHENT iF THE /'~ RE:S ! DEIqC::E'" 'i E; F:EMCE::,E:L. ED ]"0 l NC:L..U[:,E t'!CkRE 'I"HF!N 4 E:EE:,F4:'.OC'$1S. /) .,..,~,,,,~(~z~t~' ................................... ........ ............... ...................... ......................... - '; F¢::'PL. i CFthFF ii>F&.E E. SCHRF!HH. FOR: LEGAL DESCRIPTION: / 2 2,') -4 6 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SLOPE DATE PERFORMED: 9 l0 11 12 13- 14 15 16- 17 18 19 2O ~OUND WATER ERED? I:~' SOILS LOG [] PERCOLATION TESF C. Reld, Jr, No, 2251-E ¢hl :! PERFORMED BY: ~ ~:7~:' ~i ~_.l ~ >! SITE PLAN IDate Gross Net Depth to Net Time Time Wa~er Drop (minutes/inch) ' ':~ FT TEST RUN BE'FWEEN ) FT AND 72-008 (6/79) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST SOILS LOG PERCOLATION ]-EST PERFORMED FOR: LEGAL DESCRIPTION: 6 ,7 8 9 10 11 12 13 14 15 16 17 18 19 20 SLOPE COMMENTS_ /~,2-~_.~ /?',.~2~ DATE PERFORMED: SITE PLAN WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? PERFORMED BY: Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE /~ (minutes/inch) TEST RUN BETWEEN -~ FT AND "-~ ~ '-"~,¢ FT 72-008 (6/79) Parcel I.D. # DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services ~ ES D/VISION On-Site Servicfs Section ~ 0 4 1997 P.O. Box 196650 Anchorage, Alaska 99519-6650 3.3-.744 RECEi VED GERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING GENERAL INFORMATION Complete legal description Location (site address or directions) ~v.. '6, bo'T'7 Property owner Mailing address Lending agency Mailing address Agent Address Day phone Day O~P k.~,~( phone Day phone :4. Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: Individual welt Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER. As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation 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. NameofFirm I'-'~lo~o~,~ .~u~-~',_L~14~~' -~.J~.. Phone Address ~ ~ /~ ~5 ~-~ ~f Engineer's signature ~ ~ Da~e DHHS SIGNATURE Approved for . '~ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91 ) Back MOA #21 Municipality of Anchorage~ : ~. . V~o DEPARTMENT OF HEALTH & HUMAN SERVICES Em/irOnmental services Division . ,,., ... ~oN 825 L Street, Room 502. Anchorag~ A aska 9950~". (907) 3~3-4~~ 0~ 1~ '~' Health AUthority Approval. Checklist . Parcel I.D.: O~- A. WELL DATA Well type '~,i~'J~- If A, B, or C, attach ADEC attar. ADEC water system number Log present (Y/N) y Date Total dePth -:' 1~5 I~ Cased to ,...i G I:- - ~' Casing h~i'g~t (above ground) Sanitary seal (Y/N) FROM WELL LOG ~ g.pi~, g.p.m. :Nitrate Collected .by: Wires properly protebted (Y/N) AT INspECtiON Other bacteria Date of test Static water level Well production WATER SAMPLE RESULTS: ColifOrm .../~/ Date of ~safi3ple: !I[Ct '7 B. SEPTIC/HOLDING T~,NK DATA Number of Compartments~'~ Cleanouts (Y/N) ~' Date installed ~';}~'~'~ Tanksze Ill~l~i~ Foundation cleanout (Y/N) ~ Depression (Y/N) ~r- High water alarm (Y/N) '~ Date of Pumping '//'5o/~7 Pumper '"'~.i4g~..,/l" C. ABSORPTION FIELD DATA ' _. Date installed "{'J~ol~' Soil fating (g.p~.d./~ ~ ~' System typic ~{~J~/g~l Length ~_~1 Width ~,.1~ Gravel thickness below pipe ' 5'1' Total depth_ . ~ '~'/ Effective absorpbon area ~'~ Monitoring Tube present (Y/N) y Depression over field (Y/N) ~ Date of adequacy test "~//~. i Results (Pass/Fait) ~" , For "'"' bedrooms Fluid depth in absorption field before test(in.); · '"" Immediately after '"'~al. water added (in.): Fluid depth '/ (ins) Minutes later: u/ Absorption rate = g.p.d. Peroxide treatment (past 12 months) (Y/N) f yes, give'date 72-026 (Rev. 3~96)* ..... E= LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles tested Size in~.gallons  ~ p~on" level at* *Datum "Pump off" level at* Septic/ho!ding tank on lot Absorption field on lot Public sewer main SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Sewer/septic service line ,On adjacent lots On adjacent lots Public sewer manhele/cleanout Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation ~I~ Property line ~[~:) t Absorption !ield. J~ Water main/service line ) ~ Surface water/drainage I'~O Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line u~,~v..~" Building foundation Surface water ~ ~ Curtain drain ~' ~'/ F. ENGINEER'S CERTIFICATION Water main/service'line Driveway, parking/vehicle storage area Wells on adjacent lots ~ I certify that I have determined thru field inspections and review of Municipal ~eCords'that'the above systems are in conformance with MOA HAA guidelines in effect on this date. Signature , ~ ~ Eng~iheer's'Name }~J~.l .~u~r~"-' .I. ...-. La~.~ Date '"A~ ~, ~'~ HAA Fee $. ,==~0 .- '~ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number 1. - GENERAL INFORMATION ~_ (a) Legal Description (include lot, block, subdiyi6ion, sect!on, town. ship, range) Loca..tion (a~ld.re~s Or directions) 5 ,e)~"Lendig~ Institution B; Ow~r/builder B; Buyer B ;'0the~ ~explain); MUNICIPALITY OF ANCHORAGE O ~'- DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRC NMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROV/~ OF ON-SITE SEWER AND WATER FACILITY Application Date Institution - :~ - Telephone )nfirmati¢ ~the state )artn ~ent of Envirbnmental Co ; ;SEWAGE Onsite Note: if corn munity well system, must have written confirmation from the State Department of Environmental conservation J'e'gality arid ~tatusl 5) 72-025 (11/84) Page 1 of Well u assification .4'/f/ Well Log Present/(~N) Total Depth /'~.--,-~"~ ? Cased to Static Water Level ,_~ Casing Height Above Ground Electrical Wiring in Conduit Separation Distances from Well: To Septic/Holding Tank on Lot MUNICIPALITY OF ANCHORAGE (MO~i HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 Legal CT/~z~~ Ifa B C, DEC a roved(Y/N) Date Compl~d ~_J/~ 7rela .~ ~epth of Grouting Pump Set At / Sanitary Seal on Casing Depression Around Wellhead (Y~ '~ "¢7~ ~"~-,~ ; On Adjoining LOtS -//J~ TO Nearest Edge of Absorption Field on Lot /~/~ ; On Adjoining Lots ~ /~ To N~rest Public Sewer Line ~ To Nearest Public Sewer ~,eanouFManho e ~/~- TO Nearest Sewer Service Line on Lot Water Sample Collected by /-~;./~ ; Date Water Sample Test Results Co me.,s ¢/Z SEPTIC/HOLDING TANK DATA Date Installed ~//~/~---'~Size 4~ ~JNo. of Compartments /1/- -, Standpipes ~) __ ..._ Air-tight Caps~J~l) Foundation Cleanout ,~, )/ Depression over Tank (Y/N~ Date Last Pumped Pumping/Maintenance Contract on File(Y/N) / r~/~__~ for Holding Tank High-Water Alarm (Y/N) ~'~/~ Temporary Holding Tank Permit (Y/N)/~'~ Separation Distances from Septic/Holding Tank: ¢~ // ~ O/~- To Building Foundation ~¢'~ To Water-Supply Well _. _ To Property Line /.~' '/ To Disposal Field ,~' To Water Main/Service Line - C~'./~ ,- To Stream, Pond, Lake, or Major Drainage Course .,.: ~"')¢~f Page I of 2 72-026~11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ,/~.~' .~/';'~(- Type of System Design Date installed ~ ~ ;/ Length of Field Width of Field Depth of Field ~ Gravel Bed Thickness ~// Square Feet of Absorption Area ~/~/~ Standpipes Present ~) Depression over Field (Y~ ¢ Date of Last ~dequacy Test Results of Last Adequacy Test .~~ ,~ ~ ~~ Separation Distance from Absorption Field: To Water-Supply Well /(x~ /TZ TO Building Foundation .d'~ / Lot ~r /~ TO Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) To Driveway, . Vehicle Storage Area /~-~/'~-~ , ~----'f'~'~//-/~ f ~ /'~ LIFT STATION Date Installed Dimensions ~ Size in Gallons Manhol~ "Pump On" Level at C~//// _ ~::~mp Off" Level at_ High Water Alarm Level at~'//~-~/ _~'"~ Vent (Y/N) ___ :do~ ~ / Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Company ,~Z'~-'~c .~ MOA No. ¢Tr'p -a"~ ~ / Receipt No. ~--) (--') / ~/~ Date of Payment ~/~ ~/~ / Amount: $ /(~ ~ Page 2 of 2 72-026 (11/84) 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 GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ~"~m /-J~'O Telephone: Home 3~,4'- ¥~-- Business ,~Z"~'3 Applicant Address I ~ ~ (c) Applicant is .(check one): Lending Institution E]~; Owner/builder ~; Buyer []; Other [] (explain); (d), 'Lending Institution I ~'"''')¢- ~'~'~' I ~b ~ J~ ~.3¢ ~'~)~._, Telephone Address :(e) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (f) TYPE OF RESIDENCE Single-Family [] Multi-Family [] Number of Bedrooms. ~ Other WATER SUPPLY . :. Individual Well [~; Communityl-1 Public [] ... Note: If community well system, must have written confirmation from the State Department of Environ mental Conservati0;n ,?. i ~;;:~ attesting to the legality and status. 4. SEWAGE DISPOSAL Onsito ~ Public I-I Community I-1 Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84} Page 1 of 2 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-si~e 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 F[~J'~ ~/'lm~.~ ! ~¢r~e./ Telephone Address /~..~.~:~ ~¢~ .~. j /~c.~or'~/~ ~ ~.~c Date II i/ ~ .e ¢-i c ac,i, ,:u .t o , p DHEP APPROVAL Approved for '1/'~' ~')bedrOOms by ~ '~;~' ~~ Approved / Disap~ved Con~:t~'nal Terms of Conditional Approval CAUTION 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 {11/84) ~y MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-~4720 Legal Description: MUNI'CIPALffY OF A~E DEPT. OF HEALTH & ENVI~AL PROT.R."'TION NOV o 8 WELL DATA Well Classification Well Log Present (Y/N) Total Depth Static Water Level ~'~ ' Casing Heigh[ Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ~r'(v',~ ~-F_ If A, B. C. D.E.C. Approved (Y/N) Y' Date Completed ~'/g-~ / ~'"'~ Yield Cased to I ~' ' Depth of Grouting Pum p Set At ~ ' Sanitary Seal on Casing (Y/N) ¥' Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N,A. Cleanout/Manhole N, ~, Water Sample Collected b~y "'r'~/''/ ¢~ O. ; On Adjoining Lots ~ I~;' t~. ; On Adjoining Lots ~ lO/' To Nearest Public Sewer To Nearest Sewer Serwce Line on Lot ; Date Il B. SEPTIC/HOLDING TANK DATA Date Installed 2t/~-/'~3 Size IO00V~! Stand p~pes (Y/N) ~ Air-tight Caps (Y/N) Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) N,~ . Holding Tank High-Water Alarm (Y/N) N,,A, No. of Compartments Foundation Cleanout (Y/N) Date Last Pumped ~1 / :for ~',~, Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank,:.~,,~v'~ To Water-Supply Well ~' ~ ::>C/'o~ ¢.0. "- To Building Foundation To Property Line ~'7 ~ To Disposal Field To Water Main/Service Line N,A-. To Stream Course ~ lot3 ' Pond. Lake, or Major Drainage Comments Per se~l-ie ¢Z.~- bd.,l~ ~ 'Fanh' ~ co, ell Page I of 2 72-026~ 11/84) C. ABSORPTION FIELD DATA Soils. Ra!ing in Absorption Strata Bate'Installed c) /I~-/~,,~ Width of Field ~'O '~ Square Feet of Absorption Area 0 Depression over Field (Y/N) N Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well /'00 To Building Foundation ~ Lot N, ~. To Water Main/Service Line /~,~. To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present (Y/N) Date of Last Adequacy Test To Property Line ~ t To Existing or Abandoned System on ; On Adjoining Lots '~ (oO ' To Cutbank (if present) N,A, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that ihave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~'~'~ '~. ~ Date Company ~'(~z~ 7~c.~,o~o:z(~'t~' MOA No. Receipt No;- ' Date of Payment Amount: $ Q1 Page 2 of 2 72-026 (11/84) P.O. BOX 6650 ANCHORAGE, ALASKA 99502-0650 (907) 264-4111 TONY KNOWLES, MA Y OR DEPARTMENT OF HEALTH & HUMAN SERVICES December 4, 1985 Theodore F. Moore, P.E. Flattop Technical Services 14520 Echo Street Anchorage, Alaska 99516 Sugject: Lot 7 Block 5 Paradise Valley Subdivision Waiver Request WR85-052 Dear Mr. Moore: The waiver issued by this Department in 1983 (the required 100 foot separation between the well and septic tank was waived to 96 feet) has been re-evaluated using the State Department of Environmental Conservation waiver evaluation guidelines. Based on this re-evaluation, please consider the existing waiver of the separation distance requirement valid. This waiver to 96 feet for the distance between the septic tank and well on the subject property is valid for the existing septic system only. Any enlargements or upgrades of the septic system invalidate this waiver. Sincerely, Stephen S. Morris Civil Engineer On-site Services SSM/ljw APPLI¢ 'NT FILLS OUT uPPER HA[ ,ONLY Phone Mailing Addre~ . , ~,~ ~,~ ~,. ~ ;. ~':. '. ~ ~.,~:~,, ;,7' ~,, ~'"'~,~-' Zip Code ' ~ ~, ''? Address Zip Code Lending Institution ~., ~,~ ' ' r';t Phone ' ~¢ ;': ~ ~ Zip Code Address Realty Co. & A~nt Phone Address Zip Code Legal Description Street Locati~ Type o[ Resi~nce ~ingle Family ~. ~ Multiple Family No. of Bedrooms ~ Other ~ Individual A~ACH WELL LOG. A walt log is required for all wells drilled since June 1975. ~ Community For wells drilled prior to that date, give well depth (attach log if available). ~ Public Utility Sewer Disposal ~/individual Year Individual Installed: ~ Public Utility When Connected to Public Utility: ~ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date inspector Inspector Inspector Inspecf~r Field Notes: MUNICIPALITY OF ANCHORAGE j~,7,.,..~ ,-..~ DEPT, OF H~ALTIt ~'~ ,/_.~,, /~ ENVIRONM2NYAL PP, OTECTION NOV 2, 8 'igd RECE! ED ( ~ APPROVED BEDROOMS *CONDITIONS OF APPROVAL ' ' ( ) DISAPPROVED Soils Rating Date Sewer Installed Well To Absorption Area .,/~:~ / Well Log Received L.~(~--- ~- ~) /' ¢ ..~ ¢. / ,.~'~ ¢~',.~ - Well to Tank ¢ ~.., Septic Tank Size /* ~) ~ ¢.) 72-023 (3182)