HomeMy WebLinkAboutT12N R3W SEC 15 SW4SE4NE4SE4 WEST 120' PARCEL 13AT12N R3W Sec 15 SW4 SE4 NE4 SE4 W120 I Parcel 13A #015-291-08 Municipality of Anchorage Page of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 o Anchorage, Alaska 99519-6650 o Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: 5'w 9 50 D8 PID Number:d /S a7 /o F -- Name: Wastewater System: ❑ New 2 Upgrade Address: 5G0/ C /aYe /�vlG� yysi6 — ABSORPTION FIELD -- Phone: No. of Bed ooms: /did 9 a Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other -- --- Soil Rating: Total Depth from original grade: IO B'-- LEGAL DESCRIPTION GPD/SA.Ft. Lot: ercg/ /.-A Block: — Subdivision: _ Depth to pipe bottom I om original grade: Gravel depth beneath pipe Ft. /v`yS'C% Ft. =J��S Gravel length: / Township: Range: Section: Fill added above original grade: _Aj `3 1,) A 5—/ —Ft. � Ft. WELL: ❑ New ❑ U awe Gravel width: 3 —F Number of lines. Distance between lines: V/,o Ft. J-D e JJ e{ Classification (Private, A,D.C): T e-1'b�epllh: Cased To: Ft. Ft. Total absorption area: !`fig SO. Ft. Pipe material: Hance! ffDPF — Date Drilled: Static Water Level: Installer: Date instal ed: Driller: TANK See 8&A1_4wf Yield Pump Set at: Casing Height Above Ground: C-- GPM Ft. —v_ Ft. --_---- — SEI9ARATION DISTANCES XSeptic ❑ Holding ❑ S.T.E.P. To Septicg Absorption Lift Holding Public/Private Manufa5Lurer:-- Capacity in gallons; C7 / 7" From Tank Field Station Tank Sewer Lines r e C l __- - Well - p /(,j / Z116 k/) ,4 /U Al/} Material: Number of Compartments: Surface '/°D 7/°d/ LIFT STATION — gallons: Manufacturer:Lne' Lot-4Size on" level at: u off' level ac High wafer alarm atFoundation yc/S�CUrtain ake & Model Electrical Inspections performed by: Drain IJ/4 Remarks: 11"14c a/ JN,j /o del -- BENCH MARK — ��[/ 'r- daYGd /D///113:6-- corG•Y'Ln �/ location and Description: ! / /U A)L'Ofllet• b� Jf' G 2, DY 9P-- VD/LQ ri//uflCA 3''�AG•.f4r�J'FdJ �,//ija✓ daeN a✓✓.�7� y'I(e e/d //j�/f �'o.ure7C -- Sfrr fr N''e /%8✓r• y ao Assumed Elevation: /00. D IL aF 9J Tia/ /fr2a o{- 5yt �ew Y1DL S//.S'Syf7r ENGINEER'S SEAL :911• 6, (y 1 ��� a 69 Dates: 1st/9 ?r 'a n•eoo Oen 0e 0ow� Inspections performed by: -S 2nd __r�V_LL_• si o•s • • ♦•e•• off, andumari"rvices.0 approval Department of Fiealt' D a LE Y C. REID, JR. V C-225••. �,, . �If e.1°`E Dates4�p /P�iesSlactn����r Reviewed and approved by:—,� �T 72-013 (Rev. 9/91) MOA 25 Permit No.5, � Q-4-") 6 Bot Page -of _3— Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box '196650 a Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Farce/ x,7.9 Leqal Description: Po,� s" i�gA-1-y wiy v?)v 71,QN 23W sir_ PID No.: 0jr1P%/-9 8 — 72-013 A (Re, 9/91) MOA 25 �1 CO 1� �.,. .. -j =vim Tli � N a to oc ®- 1. .m � � T 0 0 d b g D+F TA.vCEY A -c 30' A t3 6� A -t Sa c -F 72,5-" _.mss— y_ — EVN6B8+8%Q�AL s'�Vr ••pea.eoee •., a9 � • . uC 491H s bjo 04 B•eeY e•• 040 ji •••by as Y C. REIl), Jk. tp gip' CE -2251 S *e ,�•, ®� fe%•••••••v..••00Q�F 72-013 A (Re, 9/91) MOA 25 SILVERTIP EXCAVATION 7021 JOSEPH ST. ANCHOPAGE, Af.ASKA 99518 X7115 L INVOICE No. SOLO TO. PATRICK-_FO GERTY nnre. 10-11-85 _ _ EXCAVATION J(lh M.I IIL NANRF !)F SER41fF NAME PATRICK_ F_ OGERTY --- . V_ J pp JyqO�B HJMBER EbiIMATF STREET.... 7. jV. -.Y%. S p ..C../. --..—../.. /1 ��C!...._.__-'-. _.._._...._....._...�____.. JOE LOCATION COMMENTS ANCHORAGE AK EoH 0.0.D. cH aro cAz� o Bnn CITY__ _ STATEzla_ u_. JOP h,OYf TERMS CHECK 11 ONE ABOVE DATE OF ORDER I STARTING DATE I DATE PROMIBF,U I ORDER TAKEN BY I CUSTOMERS ORDER NO. NR. RATE DAYRATEA MPU' MED INSTALLATION OF ONE 1250 CALLON SEPTIC TANK WITH 40 FEET OF DRAIN FIELD -- 22 YDS. OF 11" MINUS DRAIN ROCK, INSTALL 120 FEET WATER SERVICE WITH ELECTRIC TO BUILDING. EXCAVATE FOR BLDG. FOUNDATION AND BACKFILL. IMPORT 18-10 YD LOADS OF PIT RUN FOR SLABS IN BUILDING, SILVERTIP EXCAVATION PAID FOR ALL SEWER PERMITS. PLEASE REMIT PAYMENT TO: SILVERTIP EXCAVATION 7021 JOSEPH ST, ANCHORAGE, AK 99518 TELEPHONE: 344-4863 TAX TOTAI, MA?ERIAL6 TOTAL IAdOR TOTAL 071-19APLEASEPAY THIS A AMOUNT $7,835 00 a�oiFocannW 7N770 rut19V � �� ��l`5i"LrvN TRIP SRead•Nr • MOR MBF 07 POLY PAK (50 SETS) 7P770 - �zyQ / �{ z o Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: P•7 TV" c /'` Jed r LEGAL DESCRIPTION: hJ P., 1 e C / /JAI) 1 6L. 2 ; 3 p `' i..; > / some 4 r , pock 6 P Satin 5 Pe /y 9 r zrrle� 6 `� / 5p) 7 l 16- 17 81920 18- 19- 20 COMMENTS DATE PERFORMEDi� I RC. �REID, JR. 71 Township, Range, Section: 77ZN !L?t-j Smc�i SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? NU _ S IF YES, AT WHAT E O hvtii 5/0'- DEPTH? _ P — E teat'? W Depth to Water After Monitoring? Data: — Reading Date Gross Time Net Time jl�vn) Depth to nF Water ) 8 y b, /1lcn S eep r 10- 0 o �Y.f7 0•to D 9T d 12 12 �'� a �fJ f1o� S/c/eS 13 I 14 I 4' /I/6 B(.✓Ntn„re 16- 17 81920 18- 19- 20 COMMENTS DATE PERFORMEDi� I RC. �REID, JR. 71 Township, Range, Section: 77ZN !L?t-j Smc�i SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? NU _ S IF YES, AT WHAT E O hvtii 5/0'- DEPTH? _ P — E teat'? W Depth to Water After Monitoring? Data: — Reading Date Gross Time Net Time jl�vn) Depth to nF Water ) Net Drop(J4) v� e v efyoqu o �Y.f7 0•to D 9T d �2 �'� a �fJ 0 • / y _r2y I j lz PERCOLATION RATE 113 (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN S _ FT AND —7/ _ FT PERFORMED BY: / ' /'?E , (' 1 4 ' Re.' — CERTIFY THAT THIS TEST WAS PERFORME=D IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: - 72 -008 (Rev. 4/85) Paye 2 0-rZ Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST c/� iLd 1�v- via i� -s�¢J /✓• o p.., �` PERFORMED FOR: � � % �i _ DATE PER FORME�iI3yry�Y /I LEGAL DESCRIPTION:I`"(__- qw,Y 2Ey ?U� t/ S�YL Township, Range, Section: T/liV 2J1 -b "P;J 5-"v, 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? _ IF YES, AT WHAT DEPTH? Depth to Water Aller Monitoring? - Date: ■■/E INN-ME � ■n. MEN t.0 111111 E MINE IN E■■ ■ Reading Date Gross Time Not Depth to of Time Water Net Drop p 9� 949 S �7+ O• 'D,� .1 rr o �k7_-- h-, 0,/-7 WAS GROUND WATER ENCOUNTERED? _ IF YES, AT WHAT DEPTH? Depth to Water Aller Monitoring? - Date: ■■/E INN-ME � ■n. MEN t.0 111111 E MINE IN E■■ ■ Reading Date Gross Time Not Depth to of Time Water Net Drop p 9� 949 S �7+ O• 'D,� .1 o �k7_-- h-, 0,/-7 PERCOLATION RATE — (minutes?inchh)) PERC HOLE DIAMETER Z TEST RUN BETWEEN _ FT AND _6' FT PE=RFORMED BY: I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: — 72-008 (Rev. 4/85) PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE 1Z DEPARTMENT OF HEALTH AND HUMAN SERVICES �( P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 L �LlvSSCl' trc'-.nV ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW950082 DESIGN ENGINEER:JAMES SIZEMOORE & ASSOCIATES OWNER NAME:FOGARTY SUSAN J & D PATRICK OWNER ADDRESS:5601 E 104Th AVE ANCHORAGE, ALASKA 99516 PARCEL ID:01529108 LEGAL DESCRIPTION: T12N R3W SEC 15 W2SW4SE4NE4SE4 PTN LOT SIZE: 39600 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: DATE ISSUED: 5/17/95 EXPIRATION DATE: 5/17/96 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICAT.'ION BY CALLING 343-4744 ( 24 HOURS ) . (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST.' BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: AT THE TIME OF CONSTRUCTION, THE ENGINEER SHALL SOIL/PERC/WATER MONITORING TEST IN THE VACINITY UPGRADE PO RECEIVED B ISSUED BY: PERFORM A OF THE DATE: �'/ 12 DATE: .j _ / 7 - / BY ........... DATE CHKD. BY ........... BAT E ............... . I ... I ... I ........................ I ........ I .......... ...: IV'I SHEET NO 0 F SUBJECT .......... T/.... JOBNO . ............................ ........................ I .......................... Lal - � 'Y" cl u V� �11 5c> James Sizemore & Associates Civil Engineers & :purveyors 6410 Switzerland Drive Anchorage, AK 99516 (907) 3415-1572 SCOPE OF WORK AND WASTEWATER DISPOSAL SYSTEM SPECIFICATIONS FOR SEPTIC SYSTEM UPGRADE OF SYSTEM LOCATED AT 5601 E 104th AVE, LEGAL T 12 R3W S15 PARCEL 13A 1.0 GENERAL 1.1 The scope of work for this project is to upgrade the existing septic system to comply with Municipality of Anchorage requirements for a four bedroom house. 1.2 The first step will be to expose the septic tank . If the existing tank is 1000 gallons as the Municipality files indicate, and the tank is in satisfactory condition, a 500 gallon tank will be added downstream of the existing tank. 1.3 The existing deep trench leachfield will be lengthened by a minimum of 7 feet with the trench having a minimum of 5.5 ft. of sewer rock beneath the drain tile. A perc test will be conducted in the accepting soil strata to insure that not more than 125 sgft per bedroom is required for the absorption area. 1.4 All construction procedures and material used to construct the system upgrade shall comply with Municipal and State requirements. 2.0 SEPTIC TANK ADDITION 2.1 Should it be necessary to increase the size of the existing septic tank a minimum of a 500 gallon tank shall be added downstream of the existing tank. The tank shall conform to Municipality of Anchorage Specifications. 2.2 The tank will be downstream and as close as possible to the existing septic tank. The tank will have a cleanout, and shall be bedded to prevent settling or shifting of the tank. 2.3 All pipe connections to the tank shall be equipped with waterproof mechanical couplings. A double cleanout shall be installed within 5 feet downstream of the tank. it a James F. Sizemore, <i o #1517E •m. 3.0 SOIL ABSORPTION DRAINFIELD ADDITION: 3.1 An extension of the existing deep trench drainfield is to be made. The bottom of the trench addition will be a minimum of 5.5 feet below the draintile in the existing trench. The extension will be a minimum of 7.0 ft. The bottom of the trench extension will be level. 3.2 Drain tile shall be attached to the end of the tile in the existing trench. A cleanout shall be placed at the end of the extension. A monitor tube shall also be placed in the extension. 3.3 Cleanout pipes and monitor tubes shall be 4" diameter. The portion of the monitor tube extending through the sewer rock shall be perforated. 3.4 Sewer rock shall be o.5 - 2.5" screened gravel with less than 3 % passing the #200 sieve. 3.5 Approved filter fabric shall be placed over the sewer rock prior to backfill. A minimum of 2 feet of soil cover is to be placed over the filter fabric. If the soil cover is less than 3.0 ft., two inches of rigid , burial type insulation will be placed over the sewer rock. 4.0 INSPECTIONS: 4.1 Engineering inspections will be required at the following: a) after exposing existing septic tank b) after setting add on tank and making pipe connections c) after excavating trench extension d) A perc test will be required before closing the trench extension e) After sewer rock & pipes are placed and connected. MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Date: April 29, 1995 To: Carol Ann Lute, Risk Management From: Les Cross, P.F., Program Manager, On-Site/Water Quality Subject: ' Fogarty claim against the Municipality Tl2N, R3W, Sec 15, Parcel 13A From the Municipal files on this property, I can relay the following information: 1. A permit was issued on 7/22/85 to construct a 3 bedroom capacity septic system for this property. (Marked "A") 2. Tile 7/22/85 permit was voided at some point, and a 4 bedroom capacity septic system permit was issued on 8/19/95. This new permit indicated that a trench 46 ft. long, with 5.5 ft. of effective gravel depth was required. This sizing equates to 500 sq. ft. of absorption area required. (Marked "B-") 3._ - An as -built inspection report dated'7/29/85 was submitted to this office by Leroy C. Reid Jr.,. the engineer on the project. This inspection report stated that the system had been constructed with a capacity of 3 bedrooms, a 1,000 gal. septic tank (3 bedroom size), a trench r length of 38.5 ft., with an absorption area of 423.5 sq. ft.(adequate for three bedrooms, but not for four) (Marked "C"). DHHS has the original of this form on file. Mr. Fogarty's paperwork included a photocopy of what appears to be this exact form, however, the copy states that the system has a 4 bedroom capacity, including a 1,250 gallon septic tank (4 bedroom size), but still indicated an absorption area of 423.5 sq. ft. (not adequate for four bedrooms). 4. In 1986, a Certificate of Health Authority Approval was issued for this property. This certificate was issued based on the data submitted by Leroy C. Reid, Jr., the engineer. Mr. Reid stamped and signed a statement saying: "As certified by my seat ... I verify that...systent is safe, functional and adequate for the number of bedrooms and type of structure indicated herein..." He indicated 4 bedrooms. Based on that information, the Certificate was issued. (Marked "D"). However, with the information in the file stating that the system was sized for only three bedrooms, this certificate should not have been issued. When Mr. Fogarty applied for a new Certificate of Health Authority Approval for a four bedroom home, I informed him that the septic tank must be verified to have a minimum capacity of 1,250 gallons and that the absorption field (trench) must be extended approximately 8 feet to meet minimum code requirements. Mr. Fogarty stated that the municipality should have informed him at the time of the system installation, and that it will cost him additional money to comply with the code now. MUNICIPALITY OF ANCHORAGE o = Department of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Date: April 28, 1995 To: Carol Ann Lute, Risk Management [ rom: Ls Cross, P.E., Program Manager, On-Site/Water Quality Subject:' Fogarty claim against the Municipality. T12N, R3W, Sec 15, Parcel 13A From the Municipal files on this property, I can relay the following information: 1. A permit was issued on 7/22/85 to construct a 3 bedroom capacity septic system for this property. (Marked "A") 2. The 7/22/85 permit was voided at some point, and a 4 bedroom capacity septic system permit was issued on 8/19/95. This new permit indicated that a trench 46 ft. long, with 5.5 ft. of effective gravel depth was required. This sizing equates to 500 sq. ft. of absorption area required. (Marked "B") 3. An as -built inspection report dated 7/29/85 was submitted to this office by Leroy C. Reid Jr., the engineer on the project. This inspection report stated that the system had been constructed with a capacity of 3 bedrooms, a 1,000 gal. septic tank (3 bedroom size), a trench length of 38.5 ft., with an absorption area of 423.5 sq. ft.(adequate for three bedrooms, but not for four) (Marked "C"). DHHS has the original of this form on file. Mr. Fogarty's paperwork included a photocopy of what appears to be this exact form, however, the copy states that the system has a 4 bedroom capacity, including a 1,250 gallon septic tank (4 bedroom size), but still indicated an absorption area of 423.5 sq. ft. (not adequate for four bedrooms). 4. In 1986, a Certificate of Health Authority Approval was issued for this property. This certificate was issued based on the data submitted by Leroy C. Reid, Jr., the engineer. Mr. Reid stamped and signed a statement saying: "As certified by my seal ... I verify that...system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein..." He indicated 4 bedrooms. Based on that information, the Certificate was issued. (Marked "D"). However, with the information in the file stating that the system was sized for only three bedrooms, this certificate should not have been issued. When Mr. Fogarty applied for a new Certificate of Health Authority Approval for a four bedroom home, I informed him that the septic tank must be verified to have a minimum capacity of 1,250 gallons and that the absorption field (trench) must be extended approximately 8 feet to meet minimum code requirements. Mr. Fogarty stated that the municipality should have informed him at the time of the system installation, and that it will cost him additional money to comply with the code now. r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 1 (ENVIRONMENTAL ENGINFERINC DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 2644720 -� ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ]NEW pp —..__ ZIM IA7�4.II iZ--_.—__--__—.-..—.7'(_`7,54'S �I UPGRADE. MAILING ADDRESS %O.aI XbsF-V� _ cam }� 2x&-1 LEGAL DESCRIPTION f5-13 A LOCATION NO. OF BEDROOMS Well Absorption arca Dw Iling I r PERMIT NO. c�Y F- Z DISTANCE TO: / -- --- --- _— _- J. -- — �?A �2L5�.- Manufacturer Maten I No. of compartments II _q capacity in gallons IF HOMEMADE: Inside length Width Liquid depth • M 2 Well Dwelling DIS] NCE 1-0. PER IN IT NO. _ O Material Li4u capacity in gallons �LManufactwti D 0Ar w`U u -e ��-- DISTANCE TO WeII�- 1 rpO�S x — Nearest I�r?� �� -- —2. - + No. of lines Length of each line 9otal length of Imes Trench width JIIT NO__—_ PERMIT as_ ow .— — Distance bet een lines '3(Q�n�hes %1/>a `f F- ---Oil-- Top of the to finish grade Material beneath the — l affecvve absorp�ti(on area Length Width Depth PERMIT NO. IV O-_--_. — - __.__ .-_ - — - _.- .-- - - _-_ - -- — — Q I� Q Type of crib Crib diameter Crib depth Total effective absorption area CL wIV r GO DISTANCE TO: Well Bellding foundation Nearest lot line w 's Class Depth Driller Distance to lot line PERMIT NO. J` Septic tank Absorption area(O DIS EANCE TO:_ Building foundation Sewer line OTHER PIPF MATERIALS b' — — C —sr--re-owU SOIL. TEST RATNG it I I NSTA I-LER Sr l l6u�E2-- -3B — _ {�. i _ REMARKS _ __ _.— - _ i - - n Moro SlTas--ga y.--- -- - - - APPROVED ----—-- DATG LEGAL ���9�8� ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS 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. A. T understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-8UILT13 WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" SIGNED DATE: ~��~~~'�^-w~~-----`~--^------`-- -= ISSUED B [ 7--^-/�-'-J-------~-�� f� p, ' DATE: 14 Q I % I I: C; 3: F" WA I I 1 (131-7 00 R"d��������' ^ -J v DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE/ AK 99501 264-4720 ���Q :1: -11- Q E3 EN DJ I �E.� PERMIT NO: 850432 DATE ISSUED: 07/22/85 APPLICANT: JIM WALLER ADDRESS: 7021 JOSEPH ANCHORAGE, AK 995113 CONTACT PHONE: 344-4863 LEGAL DFSCRIP: SUBDIVISION: NA LOT: PARC 13A BLOCK: NA SECTION: 15 TOWNSHIP: 12N RANGE: 3W LOT SIZE: 40625 (SQ"FT" OR ACRES) LDT LOCATION: MAX BEDROOMS: � Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. 13 DE�A[3 V�o~ ��ir!::"h 1 11".11 DEPTH TO PIPE BOTTOM (FT.) 4.0 4"0 4"0 GRAVEL DEPTH (FT.) 5^5` 0.5 3,5 TOTAL DEPTH (FT.) 9"5 4"5 7.5 GRAVEL WIDTH (FT") 2"5 20.0 5"0 GRAVEL LENGTH (FT") 46.0 38,0 54"0 GRAVEL VOLUME (CU"YDS.) 25.6 28"2 40"0 TANK SIZE (GALS) 1,250"0 n* 1,250.0 ** 1,250.0 ** SOIL RATING (SQ^FT./RR) -~ 125 125 125 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS 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. A. T understand that this permit is valid for a maximum of 4 bedrooms and any enlargement will require an additional permit" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-8UILT13 WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN" SIGNED DATE: ~��~~~'�^-w~~-----`~--^------`-- -= ISSUED B [ 7--^-/�-'-J-------~-�� f� p, ' DATE: I" F �����C , E"::%. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ^ R25 L STREETv ANCHORAGE, AK 99501 264-4720 MAX EIEDROOMS)�� P: /M�RANCI,'�t. DEPTH TO PITT. J -H-311011 (FT.) IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA 8UI1-DING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AG-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST 8E DONE BY A �ICENSED ELECTRICIAN" ' SIGNED DAT[�: APPLICAN �M NHLL�h ISSUED'RY DA, I' v SOILS LOG MUNICIPALITY OF ANCHORAGE a .�.. DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST PERFORMED FOR:"Tvld— "Aj I /- DATE PERFORMED: 7— LEGAL DESCRIPTION:_ J %[l/__yJ/NC�� �r SLOPE SITE PLAN 2 3 4� 7 — 'd — 8 a 10 f 11 WAS GROUND WATER ENCOUNTERED? 1 12 / �r IF YES, AT WHAT 13 DEPTH? r '# 15 16- 17 18- 19- 20- COMMENTS 8- 19- 20- COMMENTS Reading Data Gross Time Net 'rime Depth to Water Net Drop — PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN FT AND —.— FT PERFORMED BY:—I�IS� ST:15—t CERTIFI ED BY: 72-008 (6/79) DATE: 15 �•1 Parcel I.D. 015-291-08 Municipality of Anchorage On -Site Water and Wastewater Program -. (907) 343-7904 Certificate of On -Site Systems Approval 1. GENERAL INFORMATION Expiration Date: %i R, - 1 Complete legal description T12N R3W SEC 15 SW4SE4NE4SE4 W120' PARCEL 13A Location (site address) 10331 SCHNEITER DR., ANCHORAGE, AK 99516 Current Property owner(s) PAT MUNTZ Day phone Mailing address Real Estate Agent TERI PIZA Day phone 244-9900 2. TYPE OF DWELLING: ® Single Family (w/wo ADU),� F-1Duplexe J81 l I.._ .AV ❑ Multiple Dwellings (Single Family and/or Duplex) L MAR2 51Q14 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: Individual Well 0 Individual Water Storage ❑ Community Class Well ❑ Public Water System ❑ Waiver/Variance request for: NONE Received by TYPE OF WASTEWATER DISPOSAL: Individual 0 Holding Tank ❑ Community ❑ Public Sewer ❑ COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 6a ^ Date of Payment 512-51/q Receipt Number o_ -qct Iy COSA # OSI 41 100 Date j Waiver Fee $ Date of Payment Receipt Number Waiver # 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the 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 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 SPURKLAND ENGINEERING Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501 Engineer's Printed Name LARS SPURKLAND 6. DSD SIGNATURE i System #1 Approved for `1 bedrooms System #2 Approved for Disapproved Conditional approval for bedrooms Phone 279-3916 Date 3/20/14 bedrooms, with the following By; �a / /¢ �, ✓��r �/ Original Certificate Date: -3 The Murfic' I of Ankh rage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA bWe sheet r , 3 If more than I septic system is on the lot: COSA Checklist # 1 of 1 Structure served by this system 1 Certificate of On -Site Systems Approval Checklist Legal Description: T12N R3W SEC 33 SW4SE4NE4SE4W120' PARCEL 13A parcel ID: 015-291-08 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID # __ Well Log (YIN) N Date completed 7/26/85 Sanitary seal (YIN) Y Total depth 49 ft. Cased to 49 ft. FROM WELL LOG Date of test 7/26/85 Static water level 36 ft Well production 4 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 2'32 mg/L Arsenic NO ug/L Date of sample: 3113/14 B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC/STEEL Wires properly protected (YIN) Y Casing height (above ground) 12+ in. AT INSPECTION 7115/13 37 ft. 5.2 g.p.m. Collected by: ANSON MOXNESS Date installed 5/19/95 Tank size 1250 gal. Number of Compartments 2 Cleanouts (YIN) Y Foundation cleanout (YIN) Y Depression over tank (YIN) N High water alarm (YIN) N Date of pumping March 26, 2014 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed 5/19/95 Soil rating (g.p.d./ft orft2/bdrm) 125 System type TRENCH Length 46.5 ft. Width 3 ft. Gravel below pipe 5'5 ft. Total depth 9'5 ft. Eff. absorption area 511.5 ft2 Monitoring tube Y Depression over field N Date of adequacy test 7/15/13 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in absorption field before test 0 in. Water added 600 gal. New depth 1 n. Elapsed Time: 15 min. Final fluid depth 0 in. Absorption rate >= 600 9 p d Any rejuvenation treatment (past 12 mo.) (YIN & type) - If yes, give date - D. LIFT STATION Date installed Size in gallons "Pump on" level at in. "Pump off' level at Datum E. SEPARATION DISTANCES WELL ON LOT TO: Cycles tested Septic tankilift station on lot100 + Absorption field on lot 100'+ Public sewer main NA Sewer /septic service line 25'+ Animal containment areas 50+ Manhole/Access(Y/N) in. High water alarm level at Meets alarm & circuit requirements? On adjacent lots100 + On adjacent lots100+ Public sewer manhole/cleanout NA Holding tank NA Manure/animal excrete storage areas 100'+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5'+ Water main NA Water service line 10+ Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water Service line 10'+ Surface water 100'+(N.O.) Curtain drain 50+ Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 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 LARS SPURKLAND Date 3/20114 COSA brown sheet 10-10-12.doc Absorption field 51+ Surface water 100'+ (N.O.) Water main NA Driveway, parking/vehicle storage 1 i f- OF A4(giSwtt '49L litj,4�.t.i.. IARS E. SPURKtANWD , 11 0t`v 0 1lot� % sTT% 10 in. oP4�...... a4ppOO o �+ ° d0 � 10, i vJ, H a oD 5 t S q � � O%'SHANE A. HOLT�ONxO �^ LS-6914^�00 THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS, AND IS NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES, IMPROVEMENTS, OR FENCELINES. EASEMENTS OF RECORD, OTHER THAN THOSE APPEARING ON THE RECORD PLAT, ARE NOT SHOWN HEREON (UNLESS INDICATED) NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. AS -BUILT SURVEY V =30' NO CORNERS SET THIS DATE S 112 OF THE S.E. 114 IE 114 OF SECTION 15, MERIDIAN , SUBJECT TO RESTRICTIONS, AND D, IF ANY. I HEREBY CERTIFY THAT I HAVE PERFORM7SURVEYOF THE FOLLOWING DESCRIBED PROPERTY SEE DETAIL A ANCHORAGE RECORDING DISTRICT, ALASKAVISIBLE IMPROVEMENTS SITUATED THEREOTHE PROPERTY LINES AND NO VISIBLE EN EXIST OTHER THAN NOTED. DATED AT ANCHORAGE,ALASKA THIS _18TH DAY OF _FEBRUARY 2014. HOLT LAND SURVEYING 600 HIGHVIEW DRIVE 12263, FB 159-32 ANCHORAGE,AK 99515 345-5513 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES. Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# ClS–QS-Q% -- 1. GENERAL INFORMATION Complete legal description Location (site address or directions) HAA #-"RlC�scl9's -- 2.IV Properly owner ��� ��GvL ��� �— Day phone ]2-025(Rev.1/81) Front MOA#21 Mailing address— -- — Lending agency ----- Day phone — Mailing address--------- — `'.. Agent, -- — Da hone Y p " Address -- ---- -- Unless otherwise requested, i -IAA will be held for pickup. c 0 z 2. NUMBER OF BEDROOMS: —! — r� rn v zD < > ` 3. TYPE OF WATER SUPPLY:^' rn 0 Individual well ry m D n Community well o C Public water o m z NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site 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. ]2-025(Rev.1/81) 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. Name of Firms a�%��`� Sl z��%�i`��f phone ✓ `��� Address Engineer' 6. DHHS SIGNATURE Z_ Approved for bedrooms. Disapproved. Conditional approval for Additional Comments bedrooms, with the following stipulations: Date S-2? She Munlclpality 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 lenditi q ng institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025(AW.1/91) Back MOAM21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 69re-40 A T lzNV�✓Parcel I.D. A. Well Data Well type / ,1/6 If A, B, or C, attach ADEC letter. ADEC water system number t e -We/ 'tor /( lli/ Log present (Y/N) & o Q /&/ Dae completed Total depth Cased to Casing height P_ -w _ Sanitary seal (Y/N) Wires properly protected (Y/N) FROM WELL LOG Date of test "3— Static 3Static water level Well flow Tg•p•m Pump levell SEPARATION DISTANCES FROM WELL TO: Y AT INSPECTION o z m y C l/ N n�`f N rD, o C r �c jf> —g'p' �b A ` z m n C D N T 0 z Septic/holding tank on lot ��cJ ; On adjacent lots Absorption field on lot � r ; On adjacent lots / Public sewer mainPublic sewer manhole/cleanout _ , _ / / Sewer service line � � � ��- __Petroleum tank WATER SAMPLE RESULTS: ` /I Coliform � 7 Nitrate _� /� 1 r �! Other bacteria Date of sample: -Collected by: B. SEPTIC/HOLDING TANK DATA Date installed T ^ cl _Tank size _ i Z" Cleanouts (Y/N) __Foundation cleanout (Y/N) High water alarm (Y/N) N �0 _Compartments_ L_-- ___Y_Depression (Y/N) Alarm tested (Y/N) Date of pumping Pumper,���� SEPARATION DISTANCES FROM SEPTI:/HOLDING TANK TO: Well(s) on lot I _On adjacent lots _ ^ __Foundation - 2 11 To property lineAbsorption field __Water main/service line "a)1 h ) Surface water/drainage 6 f=! e — 72-026(3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" Meets MOA electricaLcddes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Manufacturer (Y/N) "Pump off" Level at tested Surface water Date installed C, Soil rating (GPD/Ft') 40 4 System type l yG•S �' 7� a �, Length tio Width 3 Gravel thickness Total depth S/I-50`-cfr/ 11 i Total absorption area -141-L%` 44!3 Cleanout present (Y/N) �i Depression over field (YIN) Date of adequacy testV- 7 L-2 Results ass/fail _j'.:� q y (p ) for L�Bedrooms Water level in absorption field before test 2 After test L Peroxide treatment (past 12 months) (Y/N) SEPARATION DISTANCE FROM ABSORPTION FIELD TO If yes, give date Well on lot��a6 On adjacent lots � Property line t To building foundation To existing or abandoned system on lot,, On adjacent lots�Cutbank zt Water main/service life i Surface water /L!U!-) L>- Driveway, parking/vehicle storage area .a Curtain drain /% E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Name Date HAA Fee $ J6V • vv Date of Payment 27/4-2 � Receipt Number O�P 72-026 (3/93)' Back Y3 Waiver Fee $ Data of Payment Receipt Number Jamas F. sizes # 1517 k A E®CT&E Environmental Services Inc. m Laboratory Division CT&E P.ef.,°, 95.1323-1 Laboratory Analysis Report Matrix WATER Client Sample ID PARCEL 13A T12N R3W SEC 1S Client Name JAMES SIZEMORE & ASSOCIATES WORK Order 13783 Ordered By Printed Date 04/13/95 10:53 hrs. Project Name Collected Date 04/07/95 Q 13:15 hrs. Project,', Received Date 04/07/95 3 15:00 hrs. PWSID UA Technical Director STEPHEN C. EDE Released By Sample Remarks: SAMPLE COLLECTED BY: J. SIZEMORE. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init --------------------------------------------------------------------------------------------------------"----------- Nitrate-N 1.20 mg/L EPA 353.2 10. 04/07/95 CMR ___________________________________________________________ * See Special Instructions Above UA = Unavailable See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than _ 200 W. Potter Drive, Anchorage, AK 99518-1605 -- Tel: (907) 562-2.343 Fax: (907) 561-5301 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA, ILLINOIS. MARYLAND, MICHIGAN, MISSOURI NBP/ JERSEY, OHIO. WEST VIRGINIA 7777, (b) Applicant Name tea (r'��'��'--Telephone Home Business Applicant Address" 4oeSoS ---- (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder; Buyer ❑ ; Other ❑ (explain); Telephone (f) Mail the HAA to the following address: Note: If community well system, must have written confirmation from the State Department of Environmental IN V l0. 11 U V l l l l l l4, ILLY VVG11 Jyo.u„ry , i IM V...N. V ......v.. v v . ....... ........ ,_......_ attesting to the legality and status. 72-026 (11184) Page 1 of 2 I 5. ENGINEERING FIRM PROVIDI INSPECTIONS, TESTS, FILE SEARCH, D. A 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 "j Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate 'for thb'riumber 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 - Telephone j�57C C3 Address ._ '(Ze>o L✓ ' a3 p_ . .F�7�e l o �j45a 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 Slate 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 cortificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engirider's,work Page'2 of ? j 72=025 (11/84) i�'.-� 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 lot, block, subdivision, section, township, range) Location (address or directions/)0q (b) Applicant Name _IzlT"i /— Telephone: Home % — Business�F Applicant Address P0� / 1/03©j (c) Applicant is (check one): Lending Institution El ; Owner/builder GfrBuyer ❑ ; Other Cl (explain); (d) Lending. Institution„ Telephone Addw:;s .--'-)— (e) Real Estate Company and Agent — — Address - — Telephone --- (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Ar Multi -Family ❑ Other Number of Bedrooms r 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 the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ 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. 72-025 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA ANl7 INFORMATION 91 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 — G S Telephone _ moo/ -so z{G Address J,200 e j_ G3 v( u vz e 5`v Date ]\�PCar.....I1 ,..s{, t?o.•c��/F'�o.zn/ u✓/ 4W v.t/ I�t�/j r11 �a/�rr'rne ��2[Pc(c a„ we �ff/ e�(//e/^1/l^(/wl4^G �i �/[i9-C.0 (H �vC..tcC 4l�l /r" Sf%!^/� 'j3) �Q'Qllro/vti/ /yX• /r /1 (Qf /�f ��^C•I�GG l6' �nn�l /rh/s/�t^. ��•¢R,.,r sem, ( �.. s•f-a-/lr� o .ti. C. Reid, . 4451.6 DHEP APPROVAL C�-o"u /) ( r, ("Q't /-- Approved for bedrooms by ar t — ze' ti/ Date Approved _ Disapproved Conditional Terms of Conditional Approval CAUTION 0 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 DFIEP 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 11-n^5 (111K41 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 MLi.IICIPALITY O(- ANCrJunl• DEPT. OF HEALTH & ONVIRONMENTAL PROTECTION 264-4720 IL Legal Description: �- _5e A. WELL DATA Well Classification tb; AaA — If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y6___W Date Completed 'rz.' 5�A{/ Yield Total Depth Cased to Depth of Grouting _ _ M�kv• Static Water Level Casing Height Above Ground — Electrical Wiring in Conduit (YO Separation Distances from Well: vi I ump Set At —tih — Sanitary Seal on Casingd— _ Depression Around Wellhead (Y& To Septic/Holding Tank on Lot __—M1 - ; On Adjoining Lots t To Nearest Edge of Absorption Field on Lot - a•0—; On Adjoining Lots — To Nearest Public Sewer Line -M A --- To Nearest Public Sewer Cleanout/Manhole AA — To Nearest Sewer Service Line on Lot f f Water Sample Collected by Water Sample Test Results Comments Date B. SEPTIC/HOLDING TANK DATA i Date Installed 7'PJ`rt�-_ Size —0- No. of Compartments Standpipes/N) _— Air -tight Caps ON) -- Foundation Cleanout N) Depression over Tank (9N) _ Date Last Pumped &XI Pumping/Maintenance Contract on File (Y/N) _ for --lJi- d Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) . �' L - Separation Distances from Septic/Holding Tank: To Water -Supply Well _—��� � To Building Foundation • 1 To Property Line -- To Disposal FieldTo Water Main/Service Line _— ( To Stream, Pond, Lake, or Major Drainage Course —�— Comments ------ - Page 1 of 2 72-026(11/84) pavt%e / 13ni� /✓/ 3k; -Se,, 15— C. 5 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design Date Installed Length of Field ?�t3 Width of Field Square Feet of Absorption Area Depression over Field (6N 6— Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well _ To Building Foundation ?�p t_f Depth of Field Gravel Bed Thickness Standpipes PresenttA) Date of Last Adequacy Test 444 r To Property Line -fid Lot uGtKGttuf ;On Adjoining Lots / To Water Main/Service Line 195- / i To Cutbank (if present) /�,� 'l90 r7` To Existing or Abandoned System on To Stream/Pond/Lake/or Major Drainage Course 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 ** Check Permitted Bedroom Rating Against HAA Request ** �ss (Y/N) p Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I/h�ave checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed rPL�Date Company ­' 4 S �% MOA No. 0 57-0,2 <! Receipt No. Date of Payment Amount: $ / rCPCocvtc�r.+(Q C'v �•r%','1,t.,•..••� crq/rvva W—J nary -�tNMe laEia�4P-e� �e—yi..t ri � k.Jh 2��,c%.•SS (, Page 2 of 2 2 W��jiin /waw/5/Pc, wt Cwc.�u.`I i`u 4�1r•.c.rf �cYcYil�ie..al •�r��co�r 5��tc '�,� .li.-. 5`i�.ti� 72-026 (11/84) O Ai' i��U ae oo *r iu GQ'I ad. .. eaasea ej,pillaae0 a.aa ... .r.. %�-aaaW.�• taro . Reid, Jr. , C� 2251•E ,� �5w A a 0QA9Fn:a•..aaaal.�AV �� Vezit d C)rd ng & 46ittezpziaed STAR ROUTE A - BOX 1560 - ANCHORAGE. ALASKA 99507 - (907) 345-4417 July 26, 1985 hom This iiay C,)ncern: The 7dell -,f Susan P.,garty at 5601 mast 104th Ave- _r_umpe, fir five hours on 7-23 ;611 total death 49'. static level 36'. ;7611 pumping four gpm f -Dr five hours an,-, cly not pump �,'�,:n to inta,e. Ise?,1w, /Z/— wuiviCIPALIiY OP FNCHORAG2 DEPL OF HEALTH F, ENVIDEP - N -AL PROTECTION `- 10 rz�c�I\fVU