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HomeMy WebLinkAboutT12N R3W SEC 15 SW4SE4NE4SE4 WEST 120' PARCEL 13A Municipality of Anchorage Page / _of Z DEPARTMENT OF HEALTH AN[::) HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. 13ox 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~'/'a ~,~¢ D ~,A PID Number: ~/'¢"~ ~'/g' ~' -- Name: 2~.~¢/',c~ ~'- ~',J-~",,~.~ /~-.;¢pr'-'/~./~ Wastewater System: [] New ~' Upgrade Address: ,~"~l~/ ~ /~,¢-/~ ~:~q~'(/ ~'C/ ~¢~/~ ABSORPTION FIELD Phone: ~¢¢ -- ~ *~ ~ ~No. of B~ooms: ~ Deep Trench BShallowTre.ch ~Bed ~Mound ~Other ' .Total Depth from original grade: LEGAL DESCRIPTION Soil Rating:,,/Z ~ "' ~ GPD/Sq. Ft~ /~' ~ / Lot: (~f¢/ /~ ~ ~ Block: Subdiv~ion: _ Depth to pipe bottom f om original grade: Gravel depth beneath pipe / /~ ~ ~ /~ ~ '~ ~, 5-/ Ft. Ft~ Gravel width: 4umber of fines: Distance between lin¢~: WELL: D New Classification (Private, A,B,C): ~epth:~ Cased TO: Total absorption area: ~ ¢ ¢ Pipe material: ~ ~¢' ~  D~te instal ed: Driller: Date Drilled: StaticW~ierLevel: Installer: /~¢¢'~0/¢ ? Casing Height Above Ground: ~' SEPARATION DISTANCES Cs~ptic ~ Holding U S.T.E.., Manufac urer: Capacity in gallons: TO Sept(c~ Absorp[ion Lift Ho[ding ~ubl[c/Priv~t( ~ / ~ ~ F¢O~ Tang Field S~ation Tank S~wer Lines ~ ¢ ~ ¢ , Material: Number of Compartments: w~,, /¢~ z¢~ ~/~ ~/g ¢/~ ~-~/ z _ su~f~o. 2/¢¢ ~/¢¢/ L~FT STATION Water -- Lot Size in gallens: ~ Manufacturer:~ ~ Line ~¢Y ~ ~ "Pump on" level at: /~ u~¢off" level at: High water alarm at: Foundation 2t/,~ ' ~/ ~ ~ Curtain W~4 ~ ~~ Pump Make & Model ~ Electrical Inspections performed by: Drain Remarks: ~ ¢~,¢c~ ~*/,~/~ ~¢~ ~ ¢~/~/'/ BENCH MARK _ Location and Description: ~¢~ ~¢¢~ /¢~'" Assumed Elevation: /~' ~ Inspections performed by: ~ ~, ~ ~'~ Dates: lst~7//¢/¢~- "/~'" /~'- "':~" 2nd_[~ ~,/ 7~ ' . Department of Healthand Human 8~rvices approval ,,¢~ ,., ,,, Reviewed and approved by: ate:5-'~3 -Z~ 72 013 IRev 9191) MOA 25 Permit No. 5'/-,~ ~.~-b& ~',~. Page ~2 _ of "~ _ Municipality of Anchorage DEPARTMENT OF HEALTH AN[) HUMAN SF. RVICES ENVIRONMENTAL SERVICES DIVISION P.O, Box '196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Legal Description: ~"~ s~.~, ~'~R/ ,Vu~? ~'~ 7'/~/U/~..~ ~'z~'_ PID No,: ~?~-~ ~/'~ ~ 72-013 A (Rev. 9/91) MOA 25 $1LVERTIP EXCAVATION 7021 JOSEPH ST. ANCHOP:AGE, ALASKA 99518 [ UTBI~ solo to. PATRICK FOGERTY ~OAIH ....... 10-I1-85 EXCAVATION .............................. 5~g.~ .., ;.j ...................... 7~.;~ ~F ~s~w~F ................. NAME ..... P_ATR~'CK ~? .... T IZ !U ~J.YL' ~,..~..1~ ...... I~£~._~-~ ................... INSTALLATION OF ONE 1250 GALLON SEPTIC TANK WITH 40 FEET OF DRAIN FIELD - 22 YDS. OF 1½" MIN~S 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 ~LABS IN BUILDING, SILVERTIP EXCAVATION PAID FOR ALL SEWER PERMITS, PLEASE REMIT pAYMENT TO; ~!~® 7W770 TRIP POLY PAK (80 SETS) 7P770 SILV~RTIP EXCAVATION 7021 JOSEPH ST. ANCHORAGE, AK 99b18 TELEPHONE: 344-4863 THIS AMOUNT $7,835 O0 Municipalily of Anchorage DEPARTMENT OF HEALTH & H[JMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LE6AL DESCRIPTION: /¢,~Z.-, %'/..~h,,..C~-+/U.q-~,,'$/¢'~ Township, Range, Section: 7-/,~/j /~..:2z~' ,~¢¢~z/a~. /,5"- .j~,p~.~.~..¢/ /.?/¢) SLOPE SITE PLAN OL. WAS GROUND WATER ENCOUNTERED? S IF YES, AT WHAT ~) DEPTH? p E Depth to Water After Moniloring? Date: 1 2 3 4 5 6 7- 8~ 9- 10- 11 12 13 14 15 16 17 18 19- 20- Gross Net Depth to- e/~ Net Reading Date Time Time (t4 I~ ) Water (~) D rop(~.¢) PERCOLATION RATE . 'fl_ST RUN BETWEEN /~ -~ (minutes/inch) PERC HOLE DIAMETER __ COMMENTS PERFORMED BY: ~' /'~.' O/ I Z' "~e., 0/ CERTIFY TFIAT TI-IIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) PERFORMED FOR: LEGAL D ESCR I PTION: J'd'J~'~- 1 2 3 4 5- 6- 7- 9~ 10 13 14 18 ~9- 20- Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST WAS GROUND WATER ENCOUNTERED? DATE Township, Range, Section: SLOPE IF YES, AT WHAT DEPTH? Depth to Water Alter ~tonit0rino? . Date:. Gross Net Depth to' el: Net Reading Date Time Time Water Drop PERCOLATION RATE /~ '-~ _ (m~nutes/inch) PERC HOLE DIAMETER . / ~-- TEST RUN BETWEEN ~_ FT AND _ ~.~ * FT COMMENTS PERFORMED 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 ]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:SW950082 DESIGN ENGINEER:JAMES SIZEMOORE & ASSOCIATES OWNER NAME:FOGARTY SUSAN J & D PATRICK OWNER ADDRESS:5601 E 104TH AVE ANCHORAGE, ALASKA 99516 DATE ISSUED: 5/17/95 EXPIRATION DATE: 5/17/96 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: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: AT THE TIME OF CONSTRUCTION, SOIL/PERC/WATER MONITORING TEST IN THE VACINITY OF THE UPGRADE PORTal.OF THE ABSO?~0N FIELD. ~ RECEIVED BY THE ENGINEER SHALL PERFORM A DATE: CHKD. BY ........... DATE ............... SHEET NO, ....... Of ....~.: ..... JOB NO .................................... 6410 Switzerland Drive (907) 345-1572 James Sizemore & Associates Civil Engineers & Surveyors Anchorage, AK 99516 SCOPE OF WORK AND WASTEWATER DISPOSAL SYSTEM SPECiFICATiONS FOR SEPTIC SYSTEM UPGRADE OF SYSTEM LOCATED AT 5601 E 104th AVE, LEGAL TI2N R3W Sl5 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 fl. 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 sqfl 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 Specificatioas. 2.2 The tank will be downstream and as close as possible to the existing septic tank. The tank will have a eleanout, and shall be bedded to prevent settling or shil2ing 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. 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 wilt 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 CIeanout pipes and monitor tubes shall be 4" diameter. The portion of the monitor tube extending ttu'ough the sewer rock shall be perforated. 3.4 Sewer rock shall be o.5 - 2.5" screened gravel witb 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 12., 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 arid 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 28, 1995 To: _ Caxol Ann Lute, Risk Management From: s Cross, P.E., Program Manager, On-S~te/Water Quahty Subject: Fogarty claim agaiast the Municipality. TI2N, 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. (Mm'ked "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 ~ igsued 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 statemeut saying: "As certified by my seal...l verify that...systen~ is safe, functional and adequate for the number of bedrooms and type of structure indicated heroin..." 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 Departmeut of ltealth and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Date: April 28, 1995 To: _ Carol Ami Lute, Risk Management l~rom: C s Cross, P.E., Program Manager, On-Stte/Water Quality Subject: Fogarty claim against tile Municipality. TI2N, 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 ad absorption area of 423.5 sq. ft. (not adequate for four bedrooms). 4. In 1986, a Certificate of Health Authority Approval was lgsued 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...l 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 iuformafion, 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 shoulct not have been issued. When Mr. Fogarty applied for a new Certificate of Health Authority Approval for a four beckoom 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 tile 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 aow. 1. MUNICIPALITY OF ANCHORAGE DEPARTMENT OF IJEALI'I4 & ENVIRONMENTAl. PROTECI'ION ENVIRONMENI'AL ENGINEERING DIVh~ION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME ~PHOkI~ T [~J~NEW MAILING ADDRESS I EGAL DESCRIPTION LOCATION NO. OF .EDROOMS ¥01~ O~ I~le [o Jil~sH ¥a8~ Material beneati~ [iJ~ / - i'~tal effective absoq)tion area (z!~iOSa!Ds I STA N C E TO: Woll PERMIT NO. Crib deptll Total effective absorption area Sewar line Septic tank ' ~&BsOFplir,;;~;ea(sl OTHER '~PE MATERIALS SOIL. TEST RATFNG INSTALLER REMAiRKS APPROVED DATE lEGAL Pt!;RM I 'f' I',IO: 8504:252 DATE ):SSUED: ()?/22/85 995 :L 8 LEGAL ;OESCI:':::I:F:': SLJBD:I: V I,¢31 (]IqL~ NA I,,.,(]T: PARC :[3A BI .OCI<: NA SECTION: 15 ]'OWNSI. tIF': 12N RANGE~ 3W I.,.OT S I ZE: 4()625 (SI:;~. FT. (:)R AE;RES L.[IT LOCATIONx IdAX BIEDROOIdS~ system,, Chocxse the optJ. on tha't, best "11~' ~::::~: EE: ~',a ~::;¢ ~*-~ :E~ ~EE :1[]~ ~;k~ .. ]2) ~1: ~':::~ % 1l",4i DEP'I"H 'T'O P I I:::'E BO'I"TOM (F'T,,) 4,, () 4.0 'q.. 0 GF;:AVliEL DIEI='TI-I (FT.) 5.5 ' O. 5 3,, 5 TO'I'AI.~ DEP]'H (1= l". ) 9., ~; 4... 5 7., 5 GRAVIEI.. WIDTH (1='"1 ,. ) 2,. 5 20,, () 5,. 0 GRAVEl,.. LENGTH (F:T.,) 46.0 38,, () 54,, 0 GRAVEL VOI...UME (CU. YDS,. ) 25.6 28.2 4(). C) SOIl,. RA'f'ING (SQ.F"T'. /BR) ..... 125 125 125 .x-.~. 'I"ANK PILJ,;~ f HAVE AT LEAS] ]W(] C(::)MPAF;:TMEI',I'FS I ocr'ti fy 'Lha'L: 1. :1: ant familial* for'th by the MLU"l;Lc;ipa]ity o~' Ancl'~or'age (MOA) and 'Lhe State of' A],asl<a,, I w:i. ll :ir'~sta].]. 1:,he !;ilyi~',,(:¢~ :i. ll a;tCCOI'ClaU'H:;;E) ~d. th all. MOA (:;c)d~DE6 at-id af]d iii (]ompliar~ce wi'Lb 'Lhe dr=)s~,g]'~ cr,:i, tE~r,:i.a c~' 'Lh:J.~ I wi]l,] adhel'e to) all MOA and State of Alaska f'eqL.Lil'eCflE,~Flts ~'[:)P 'LhE~ sot back I t~r'ider's'Larld 'Lha'L 'Lhis p<.2i'r0:lt ~,s va],J,d FOP a fliaxiifltzm Cl[' 4, bsd['c)(:3if)!3 al"id I I:;:' A I. I I="f' ,~ I A1 ]: (:)hi ]: S 1N.~ I AL.L.,I:::,I,) I I',l AN ARIEA C(]VEI:~ED BY MOA E U I [ D ( NG (.,0I}1:::.::~, ]HEN (1) f~lxl EI.JECTRICAL I='ERI~iI1'' AND INSPECTZ(3N MUST BE ~I3TAZNED~ (2) AS'"'BUILTS WIL, L NOT BE AI::'I='ROVED NITHOLI'I~ AN EL.ECTRICAI.,,. INSI='ECTIOIq RIEP[iR]"; AND (3) THE IEL. ECTF~ZC~II.. WORK MI,,IST BE DONE BY A L]:CIENSED ELJE[:'I'I:~ICIAN. DEPART'HENT OF: HEAL./I']--I AND ENVIRONMEN'lT.~L, PR(]TECTION 825 I.. STT~EET!, AiqC'H(]RAGIE ~--I--Iq.~r I C'AI I1" AD DI::~E'S f:i~ : CON]' ACT PI"ICII',IE: JIM WALLER '7()~7, :1. JOBE:'PH ANCHOR~[:iE, AK 34/I. - 48 &:L""; 9 9 5 11i3 I.,EGAL DESC, R ]:P ~ I,..C)T !iLl: ZE, LO]" L. OCAT '[ I]1',1 MAX BEDROOMS system. [lhoose the option that L.[]'T: I::'AFiC :I. 3A l~l (ICl... I".IA RANGE: :::~W I3RAVEI,.. W I D'I"H (F:"f'.) / 2 ,, 5 17.0 E ,, 0 "', ......... :" ' / '~ ~:~ "l ;~J.. l") 4 ] ,," ~--"'~" M'~AVEI,.. I,..I::.NI311'I ([ 1 . ) / ...... ~ .......... (:IRAVI:I.. VOLLJI~E. (L,LI,, VI}S,, ) ./ ~,.~ ..... L,,,J .... U,, 4 "I'AIqI'::: S I ZE ((3AI,.S) / 1,00(). () '""~' J., 0c])0. C) ';"~ 1,000. () '~"~' SO 1L. KAI l Nb (,:sl,l ,, I'" t . /HtK ) 1,=,.~ .[,=,,; 1,..,,* ~ ~ I cer"e.:ity that,, / / 1. I am t'am:i, li~(r. ~ith the requir~m~nt[i fop on.--sit~er'~'~rH:] we~is as set for'th by the MLu]:[cipal~ty of And"lor'age (MO~) arid ~dtaCe of Alaska. 2. :[ w:i.],l irls'~.a].], th(~; f~yst,[:});[I J.r'l accor'dance wit. Ii all MOA codes arid and in compliance with 'the des:i, gn cr, itel,:i,a oF this p~pm~t,, 3. I will adlaert~] to all I1[]h ar'id ~H:,a'L[~ of Alaska r, equ:i, remen'L~s for the ~e'[. bac:l.:: di!~iLal'lCe~ f'l'Olll any exist:Lng wel],~, was'Lowater' disposal sy~stem or' public !~ewerage sys'Lem orl 'Lhis or arly adjac:ent, of r'lear'by lot,, 4. I L.u]dBI"[~'L~.~ild 'Lhalt. '[,hi~5 j::l~epmit :i.~B valid fop a maximum Of 3 bBdl"C)l:]ms arid any (~)n],arg(~ement w:i. 1], reqL[il'la an mdditiorla], pel',mit.. ],,:~, II',.I~.~TAt.,LIED IN AN AREA COVEFRED BY M[IA BLJILDIIqG CODEZS, II::r A LII:::']' S'FATIOIq 'c, THEN (1) AN I:.L.I~.CI~ 1CAL. F'ERWIT AND 1N~I~:L, Ii[IN MU,:I1 BE OBTAINED; (~.) A,..~ BUJ. LI,..~ WII_I,. IxlO'I" BE AFFI~OVED:"' WI'l]-40UT AN E,I.,EI.tF(.[[,AI_ ,[N,~I I:[,]ION REF'ORI"~. AND C.:,) "FHE I.I...[ I,,IF~II..,AI.. WI]RK MUST BE DONE BY A I,.ICENSED LI,..LL, 11~I[ lAN. API::'I.. I CAll'el WALLER ; MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 925 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG -- PERCOLATION TEST SOILS LOG L1 PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: SITE PLAN 10 11 12 13 14- 15- 16- 17- 18- 19- 20- WASGROUNDWATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time 'rime Water Drop PERCOLATION RATE (minutes/inch) COMMENTS_f :"-D TEST RUN BETWEEN 72-008 (6179) Parcel I.D. if 1. 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 ~ \ - t(~)~ HAA# ~ GENERAL INFORMATION Location (site address or directions) Property owner ' 'Mailing addresS' ' Lending agehcy ":::; · Mailing address A~ldress [)ay phone r)ay phone __ [)ay phoqe e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: ~ TYPE OF WATER SUPPLY: Individual well Community well Public water NOTE: TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community well system, provide written confirmation from Sta.!? ADEC attest- ing to the legality and status of system. .. .~ J )/~,. ., ', ', "~ If community wastewater system, provide written confirmation from State ADEC attesting to the legali~ and status of system. 72*025 (Rev. 1/§1) Ftonl MOA#2~ 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 verifythat 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, /~2'~"~ ~--~--/~~~/~ Phone ~'--/'~,, Address ~'~'/O Engineers signatur~~~ ~~~ Date ~'/ DHHS SIGNATURE Approved for ¢ Disapproved. Conditional approval for bedrooms. bedrooms, with the following stipulations: Additional Comments Date ~--2 ~' -/o_,~ , · ',.,The Mun[cjpahty ,of,Anchorage Department of Health and Human Services (DHHS) issues Health Authority · ';Approval¢~',ertificats&' b'~sed only upon the representations given in paragraph 5 above by an independent p crees onal eng neet reg stered m the State of A aska. The DHHS does th s as a courtesy to purchasers of homes and tidbit, lending institutions in order to sat sfy certa n 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. Municipality of Anchorage Department of Health and Fluman Services HEALTH AU'rHORITY APPROVAl. CHECKLIST A. Well Data Well type /~/7 - If A, B, or,C,, at..tach.ADEC letter. ADEC water system number ~ ~.~ wen f'ao,~Cf'/a,/~ ~.rl'Y.¢ ..... .¢ Log present (Y/N)~,/!/? ,¢~}¢'//¢'P ~ I Date completed , Unlle __ Totaldapth Casedto :? Casingha,ght Sanitary seal (Y/N) ~/ Wires properly protected (Y/N) ~f FROM WELL LOG SEPARATION DISTANCES FROM WELL TO: Date of test Static water level Well flow Pump leyell g.p.m. Septic/holding tank on lot Absorption field on lot Public sewer main / // Sewer service line / c~ ,C// ;On adjacentlots _ .?_- ~¢.~¢ ? &~&' ~;' On adjacent lots /~J/~. / ~ Public sewer manhole/cleanout · ~L? (~._} Petroleum tank Nitrate Collected by: -~ ] -¢ WATER SAMPLE RESULTS: Coliform Date of sample: B. SEPTIC/HOLDING TANK DATA Date installed '~ '-"~¢'~ Cleanouts (Y/N) _ High water alarm (Y/I~) Date of pumping Other bacteria r "~ Compartments Depression(Y/N) Alarm tested..(Y/N). SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ~. c~ ~} On adjacent lots TO property line ~.1~/ Absorption field Surface water/drainage /'V' (0/4 ~ Foundation '~--~ Water main/service line 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) "Pump on" lev'~e~P~-~,'~'~ High water alarm level .j ~- ~'"'"C~el~s Meets MOA~kc d0~es (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: \ Manufacturer ~ Man~a~le/Access (Y/N) "Pump off" Level at tested Well on lot On adjacent lots Sudace water D. ABSORPTION FIELD DATA Date installed /~//[~/~¢'~ So,lrating(GPD/FF) ~ /~'~.. Length ~d ~ ~- ?¥,u Width ,~ ~ Gravel thickness ~?~ ~i Total absorption area ~, '~- '~'~ ~ Cleanout present (Y/N) ,/~/ Dateofadoquaoytes, ~,,/7/¢~y Results(pass/fail) 1~~:~-~-~. -- Water level in absorption field before test '~'- ' ~' Peroxide treatment (past 12 months) (Y/N) /~ ~ System type ~'~/~,~ Total depth Depression over field (Y/N) ,/0/ for *~ ,~ Bedrooms After test ~ ' If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot ~ ~'~ ~"- '" On adjacent lots To building foundation On adjacent lots Surface water A~L~ ~ Curtain drain ?~ © ~'~ ~' Property line 7~2('~ //~/~ TO existing or abandoned system on lot ~,.-¢/~///' Cutbank /¢~k~ Water main/service li~e /~¢ ~ Driveway, parking/vehicle storage area --~) / (~¢ ! E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to afl MOA and HAA guidelines in effect on the date of this inspection. # 1517 HAAFee$ J~. ~ Date of Payment ~ 7~:~'~/,-~'~''~ Receipt Number ~d) ~z ~ ~ 72-026(3/93)* Back Waiver Fee $ Date of Payment Receipt Number CT&E Ref.~ Matrix Client Sample ID CT&E Environmental Services Inc. Laboratory Division ~'.~J,~',~'~'~',~,e',,~,e',~,~,a~',e'~',e'.~.~.~JfJjjJJJJ~vJJJJ~~ Laboratory Analysis Report Client Name JA~4ES SIZEMORE & ASSOCIATES WORK Order 13783 Ordered By Prinned Date 04/13/95 ~ 10:53 hrs. Project Name Collected Date 04/07/95 ~ 13:15 hrs. Project~ Received Date 04/07/95 ~ 15:00 hrs. PWSID UA Technical Director STEPHEN C. EDE Sample Remarks: S~PLE COLLECTED BY: J. SIZEMORE. QC Allowable Ext. Anal Parameter Results Qual Units Nethod Limits Date Date Init Nitrate-N 1~20 m~/L EPA 153~2 10. 04/07/95 CSIR See Special Instructions Above UA = Unavailable See Sample Remarks ;Coove NA = Not ~nalyzed Undetected, Reported value is the practical q~/antification limit. LT = Less Than Secondary dilution. GT = Greater Than 200 W, P0~e~ Ddve, Anchora§e, AK 99518-1605 -- Yell (907) 562-2343 ~sx~ (907) 5~1-5301 ENVIROFIMENTAL FACILITIES IN ALASKA, CALIFORNIA. FLORIDA, ILLINOIS. MARYLAND. ~RCHIGAN, NIISSOURI. NEW JERSEY, OHIO. WEST VIRGINIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ~ DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF iNSPECTION FOR HEALTH AUTHORITY APPROVAL. OF ON-S TE SEWER AND WATER FACILITY 264..4720 GENERAL INFORMATION (a) Legal Description tnclude IO[, blocK, subdivision, section, township, range) Location [aeuress or directions) ¢7¢~ [ ~ ' t~'C"~'c--P---';' ~'~ ' 1:~1~ h'one?'ome" Apphcant Name _ -- 7._~_p ~ Z~ ' nt A s ~..-C~. ,~,./, a:~C~.~:::'-~' "' Apphca ddre s (b) (c} Applicant ~s check one,. Lending Institution []; Owner/builder'S; Buyer []; Other'D texplain); re) (f) Telepnone Lenmng nstitution Address , =teal Estate Company ane Agent Address Telephone Mail the HAA to the following address: 2_ TYPE OF RESIDENCE ' ,'"~Single-Family'~l. Multi. Family [] Other ndvdua We ~ Communty ~ Fubhc Note; If community well system, must have written confirmation from the State Department of Environmental Conservation ('.. attesting to the legality and status.-.. :;), .,Ons~t~(h Pubhc ~ .:,:,Commumty u Holdmg_~apk,U "attestingN°te:lfc°mmunitywellsystem'musthavewr ttenoonf rmation 'romtheStateDepartmen(of EnvironmentalConsemati°nto the legality and status. ' " ' ' ': ; ' Page 1 of 2 ' 5. ENGINEERING FIRM PROVIDI INSPECTIONS, TESTS, FILE SEARCH, D ~, AND INFORMATION ~ . - As certified by rey seal affixed hereto and as of the validation date sh 3wn oelow I verify that my investigation of this Health ;', .iAu~ihori!y Appr6v~il ~howe that the on.site Water supp y and/o}.wastewater d sposa systom s safe funct ona a ~d adequate L &~r ''for ths;r~dr~ber of bedl;(~dms and type of structure ih;dlc~ted h~rein. ' further verify that based on the r~formation obtained from the' Munic pality bf Anchorage files and from my' investlgatior anc inspection, the on-s~[e water supply and/or wastewater disposal sys[em ~s m compliance with all Munic Ds and State coees or(]mances, and regulations in effect on [ne date of this inspecuon Name of FiCm Address Date..,I .! ,~ ,, -," -,.,' ,,i,:',,..' :;' ', ";,.',: d.!'~, ., , ,~.. ,. '~ ,f..., ,'~,-~,:: ~,~ ,,.- DHEP APPI~ OVAL Approved for -~o.-c~-' ~?'~edrooms by Approved ' Disapproved Conditional Terms of Conditional A'pproval ,, Date ']'he 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 bertificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the prbfessio'nal en gi~e'~i:'~i~o'r MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HI-'ALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE S[--WER AND WATER FACILITY 264-4720 Application Date ~'~ ~'/~ <¢'~-D GENERAL INFORMATION fa) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) ,/' Applicant Name ~¢¢c& ~¢~--~ --Telephone: Home - ¢/ Applicant Address _ ¢0 ~ (b) Business -~'~' (~" / (c) Applicant is (check one): Lending institution []; Owner/builder ~i/]':'Buyer []; Other [] (explain); (d) Lending, lnstit.ution,, ' '' )- (e) Real Estate Company and Agent Telephone Address Telephone fi) Mail the HAA to the following address: TYPI-' OF RESIDENCE Single-Family,[~ Multi-Family [] Number of Bedrooms ~ Other WATER SUPPLY WellW Community [] Public [] Individual H Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWA~/~ISPOSAL Onsite/~] Public [] Community [] Holding Tank [] Noteif'lf community well system, must have written confirmation from the State Department el Environmental Conservation attesting to the legality and status. 72-025 (11/84) Paee I of 2 ENGINEERING FIRM PROVIDING INSPECTIONS, Tr:STS, FILE SEARCH, DATA ANI~ 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 lhe date of this inspection. Name of Firm ~ ~'-~ ~ ..~L C Telephone Address 1~ ¢'~ ~'~ , ~C~ ~ ~ ~'¢~ Date ~/~¢ ¢ DHEP APPROVAL Approved for __ ~:'~,,,-," bedrooms by '~' Approved Disapproved Conditional Terms of Conditional Approval Dale CAUTION The Muncipality of Anchorage Depadment 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 Mueicipelity of Ancborage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 Legal Description: WELL DATA Well GlassifJcatJon ~O If A, B, G, D.E.C. Approved (Y/N) Well Log Present (Y(CJ~, -~ Date Oompleted _/'~'/~'r./-~~-~ Yield Total Depth __ ~ _ Cased to ~ Depth of Grouttng ~A~'~g Static Water Level ~ r Pump Set At ~¢~ Casing Height Above Ground Electrical Wiring in Conduit (Y~.)~ Separation Distances from Well: To Septic/Holding Tank on Lot _ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line ~/~/A Cleanout/Manhole _ Sample Collected by _ ~]~-~ t ¢2"~ , Water Water Sample Test Results Sanitary Seal on Cas ng~ Depression Around Wellhead (Y~ ; On Adjoining Lots ~-.;zO · ; On Adjoining Lots /OO _ To Nearest Public Sewer __ To Nearest Sewer Service Line on Lot ;Date __¢.0 ,-,.~,~2 SEPTIC/HOLDING TANK DATA Date Installed 7~:~"r~:~/ _ Size /O~/0 _ No. of Compartments Standpipes0/N)- _ Air-tight Caps gN) Foundation Cleanout~N) Depression over Tank CN) Date Last Pumped Pumping/Maintenance Contrsct on File (Y/N) /~ ;for Holding Tank High-Water Alarm (Y/N) /~4 __ Temporary Holding Tank Permit (Y/N) "(J~- - Separation Distances from Septic/Holding Tank: TO Water-Supply Well [¢/~'/' To Building Feundation ~"~'F. To Property Line ___ /0 I~ To Disposal Field To Water Main/Service Line .~ To Stream, Pond, Lake. or Major Drainage Course I~t Comments Page I of 2 72-026(1U84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field _ Square Feet of Absorption Area ~.-~.~ Depression over Field ('~ Results of Last Adequacy Test /~/~, Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot [~ To Water Main/Service Line ~ 5" /'f To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Type of System Design Length of Field _ %~'~., ~- Depth of Field _ ~ Gravel Bed Thickness · ~ Standpipes Present Date of Last Adequacy Test t To Property Line :-:~¢ % To Existing or Abandoned System on ; On Adjoining Lots r~C:~ t,C- TO Cutbank (if present) _ /'~'~¢/~ 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 ~ ~anhole/~'~ess (Y/N) P ;~IN~t 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. Date MOA Signed _ ~'~ ~:~-'"".---... Company ~'( Receipt No. Date of Payment Amount: 72-026 (11/84) STAR ROUTE A- BOX 1560-ANCHORAGE ALASKA 99507-(907) 345-4417 July 26, 1985 T d;hom This May C'}ncern: The Well :)f Susan F,:garty f r five hours on ?-23-85. at 5601 Cast 104ti} Ave. ~umpe; ',Yell total de~th 49' ot~tzc leve= 36' ,',,'ell pumping f:)ur gpm for five hours aha dawn to intake. not pump