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HomeMy WebLinkAboutT12N R3W SEC 15 LT 14T12N R3W ec. 15 Lot 14 x#015-112-27 kI \GV VJIVGI I Vi Municipality of Anchorage On-Site Water and Wastewater Section • (907) 343-7904 Page 1 of 2 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181233 PID Number: 015-112-27 Dwelling: F0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New Q Upgrade Name Lester & Vicki Lewis ABSORPTION FIELD 0 Deep Trench E] Wide Trench El Bed E] Mound ss Site Address 4400 E 104TH Ave ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.6 GPD/SF 11.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original 4.0 grade Ft. Gravel depth beneath pipe 7.0 Ft. Subdivision Block Lot 14 Fill added above original grade 0.0 Ft. Gravel length 75.0 Ft. Township Range Section 12N 3W 15 Gravel width 2.5 Ft. Beds: n/a Number of Lines Distance between lines n/a Ft. SEPARATION DISTANCES To Septic Absorption Lift Station I Holding I Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 1050 Ftz 1 14'+ Ft. Well 100'+ 100'+ 100'+ TANK ❑e Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Greer Capacity 1250 Gal. Surface Water 100'+ 100'+ Material Number of compartments Lot Line 5'+ 10'+ NA Plastic 2 Foundation 10'+ 10'+ I LIFT STATION Manufacturer Capacity Remarks 14' min between abandoned field and new field Gal. Alarm location Electrical installed by PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield Installer Isaacs Excavating Services Drainfield 3034 Co/MT 3034 Inspector Pannone Engineering BENCH MARK (Assumed elevation) 96.5 ft Inspectio v 5/8/19 7/19/19 Location and description 3`d 7/19/19 Znd 41 2/5/2020 Concrete pad under porch. ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: OF Date ,�� -co 491H • Steven � •P<�r�nore•� Septic System CE 8149 Approved Date Note: this approval do not include well permit requirements. kI \GV VJIVGI I Vi �K:--1-10nm��D 40000--m (T) c f ZO 5 m 11 0 n m -u --1 Mp r p p r x� m O��zo0o���< z- D r-�-�r"oC)p 20.E mIz - 0mO 1-11 ;o Z0 (n Z z ffTT7 o z OC rm- -D-t Vl r X Dr - 0 Z n �m mom o�m � 0 V c o C, - r emz C) V i-[7 z zn N / zm ;a 0 s N A a Z - G O -i m Ot m � m Q Z - 0 m m 0 - IO Ql V 01 UI �N m N N E� NOTES: RECORD DRAWING DRAWN ACP SITE PLAN V1 z C) m n m FF 0 0c"ICE o C, �cnDcon M �z a� C) V i-[7 r Drc7TC0yU N N / O N Dx �N z�xD��m� G) fJ-iDNO 1 Z 7➢ >z r �i_. J �o X Cw -P W (A 00 0) - O fn rn W O N TIp O C..1 0) 00 00 Cn Cn W C4 N o Cb OD N C,4 C,j N 10 01) - V N V in C.1 REVISIONS / DATE 2/7/2020 0c"ICE o C, �cnDcon M �z a� V i-[7 r Drc7TC0yU Fr / mb Dx �N z�xD��m� G) fJ-iDNO 1 Z 7➢ >z r �i_. J �o X om j O - N 0 Z o \1 Ln mrT, 00 0 o01 041 z O fn rn -i (n G) `n Q1 -0 p (n N TIp mm O O (7 -0 \ Fr OJ 2 -TI — — FT-, - o Z m p c/) p �- M z FNLEY-,r mlE ��� j \ � O 4 Dz / LOX m O OL"Z / Zv%ti �m O O 1 T z_ z , o C, _ I f m \ m ❑/ � V V\; / mb y 1 Z 7➢ >z r J �o As / a ORIVIyA� 0, 1 E N .ILD \ m I \ PANNONE ENG SVC LLC C.1. 1088) P.O. BOX 1807 PALMER, AK 596452/7/2020 40���0\\\ of A( REVISIONS / DATE 2/7/2020 PHONE (907) 745-8200 FAX (907 745-8201 gSIO /r�.�P• ' 9i� • *�� REV 1: REV 3Z18/2020 2: 2/17/2022 SCALE 1" = 60' TI 2N R3W SEC15 L14 2 25/2022 P.I.D. NO LESTER AND VICKI LEWIS Steven .•Pann'6re•� 015-112-27 �233 4400 E 104TH ANCHORAGE, AK E lyd,l` c ` �e S EEP18PERMIT 2 OF 2 e Building i� on-site `Rcr?er �Lp; 4700 Elnore 2oac ?._O. Box 196650 Aiichorace, i;;; 99507 r 5 : F E T Y Mark Beglch }wvnl.muni.orq/nn,i ie Mayor - (407)343-7504 VffleH Log Permit Number: OSPI81233 Date of }issue: 8/16/2018 Date Started: 8/30/18 Date Completed: 9/4/18 Is well located at approved permit location? Lxj Yes U No Legal Description: T12N R3W SEC 15 LT 14 G:2536 Property Owner Name & Address: Lewis Lester & Vicki Borehole Data: Depth (ft) Soil Type, Thickness & Water Strata From To stickup 0 2 overburden 2 4 silt & gravel 4 98 moist gravel 98 102 sand & gravel w/ little H2O 102 103 wet sand & gravel 103 110 clay 110 115 hardpan 115 165 wet silty rock 165 170 clay y 170 182 silty gravel w/ little H2O 182 185 dry silt & gravel 185 202 wet gravel 202 215 coarse sand & gravel w/ H2O 215 220 Water Sample Results: .Arsenic: Nitrates: Total Coliform Bacteria: Other Bacteria: ug/L mg/L Abs colonies/10rtIJ2. R\ -3S col/100mL Method of Drilling U air rotary U cable tool Casing type: steel Wall Thickness: .250 inches Diameter: 6 inches Depth: 220 feet Liner Type: - Diameter. inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): 170 feet ]Pumping level: feet after hours pumping gpm Recovery Rate: 20 gpm Method of Testing: airlift n Open End n Open Hole ❑ Screened Start feet Stopped feet n Perforations Start feet Stopped feet Grout Type: entonite Volume:granules Depth: 20' Start 0 feet Stopped 20 feet Pump: Intake Depth 210 feet Pump size 3/4 hp Brand Name Grundfos SQE Well Disinfected Upon Completion? n Yes n No Method of Disinfection: chlorine tablets Comments: Well Driller: Hefty Drilling, Inc. 3540 Akula Dr. Anchorage, AK 99516 Attention: The well driller shall provide a well log to DSD within 30 days of completion. C Building say b9 / Division Vfra: ,— G: V csi e€Jcv?er Pilogpaul 4700 Elmore Road ' z. z P.O. Box 196650 4 Mark Begich Anchorage, AK 99507 S A F E T Y Mayor vaimmuni.org/onsite (907) 343-7904 Pump Installation Log 1 Well Drilling Permit Number:j �� 3'� Date of Issue: J Parcel Identification Number: Legal DescriptionProperty Owner Name & Address: T -ii W/R3U/ SfC ) S LTN Lew�� Le.� 4- VIcl1� 2;3G Pump Installation Date: 3 _ / I _ / 9 Pump Intake Depth Below Top of Well Casing: ,10 feet Pump Manufacturer's Name: tsvd-g-� Pump Model:- G r L v,d kS 07 -' qO Pump Size �N hp Pitless Adapter Burial Depth: �(] feet Pitless Adapter Manufacturer's Name: Ccvwba 6 I Q Pitless Adapter Installer: Lk�� 0f,,)4%-5 Well Disinfected Upon Completiontr [R Yes n No Method of Disinfection: U Ia✓1`rC TAtvtv Comments: Pump Installer Name: ,X130 99511 Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. ma FINLEY CIRCLE (A F) N 00010'19"W 250.36' N 00010'19"W 410.03' 0 > ..... -------- 236.4'------ z corn rn OD 0 >z -j 0 O;u in 0 z w0 to C2 *z 0 0 rn fTl CJ9 R°00 z > z m rn rn OD 0 Z OD Ng go: I I r- 8 (.1 o in rn > rii 0) 0 115.1' < A 1 > z :j (0 0 rn 0 C z m rn m z (4 rn m z 0 0 0 0 0 iA 'Ez rCA p cn N 00014'18"W 660.96' > "°"""o w MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road : 7 `"M Anchorage. Alaska 99519-8650 Phone: (907) 343-7904 Fax: (907) 343-7997 � hfp:ll.muni.org/onsite xw _ On -Site Water & Wastewater System Permit Permit Number: OSP181233 Effective Date: Work Type: WellSeptic Upgrade Tax Code Number: 01511227000 Site Legal Address: T1 2N R3W SEC 15 LT 14 G:2536 Site Mailing Address: 4400 E 104TH AVE, Anchorage Owner: LEWIS LESTER & VICKI Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: 0 Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy Ment S, 10 e a O epartment Expiration Date: Lot Size in Sq Ft: Total Bedrooms: 8/16/2018 8/16/2019 206745 4 0 Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received B, Issued By: falwas MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERANELL PERMIT APPLICATION Parcel I.D. 015-122-27 Property owner(s) Lester and Vicki Lewis Day phone Mailing address 9821 Spring Hill Drive, Anchorage, AK 99507 Site address 4400 E. 104th Avenue Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T12N, R3W, Sec 15, Lot 14 Lot Size 206,745 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: t® all that apply) ❑X Absorption Field ❑X Septic Tank Q Holding Tank ❑ Privy ❑ Private Well ❑x Water Storage ❑ APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) ❑X (w/wo ADU) Upgrade ❑X Duplex (D) ❑ Renewal ❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE/ WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. r.WSTJKT Permit/Rush Fees: Ing Date of Payment: �i'/�v � Receipt Number: Permit No. 3 124 3 Permit APp_= ::_"< Waiver Fees: Date of Payment: Receipt Number: Waiver No. Municipality of Anchorage On-site Water and Wastewater Pannone Engineering ServiceS LLC REVIEWED FOR CODE COMPLIANCE OSP181233, Deb Wockenfuss, 08/16/18 Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com August 6, 2018 Subject: T12N, R3W, Sec 15, Lot 14 Well and Septic System Permit Request Design Narrative This is a design narrative for a permit to install a new well and septic system to be issued for this property. This installation will be separate from the OSP161358 permit design that will be installed in the future for a separate dwelling. The proposed systems will serve a proposed four bedroom (4) bedroom house. Currently the lot is partially developed with a garage, and the existing house already removed from the lot. The existing septic on the southern half of the lot will be reused as a reserve. The existing well will be reused as an agricultural well with hose bib connections, and a new well will be drilled per the owners request due to the silty aquafer that the existing well draws from. Nothing has been installed under OSP161358 yet. This lot and the surrounding lots are served by private wells. The well on this lot and the surrounding wells are over 100' from the septic system. 1. Soils. One test hole was performed on this lot by PES in June of 2018, and groundwater was monitored for at least seven days. Ground water was not observed to a depth of 17.0' below the surface in the test hole monitor tube after the 7 day monitoring period. Bedrock was not encountered in the test hole. Based on the results of the percolation tests and overall soils appearance; an application rate of 0.6 gallons/day/square feet was used for a conventional wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography generally slopes from the south to the north in the area surrounding the septic system at approximately 10% with a low area in the central portion of the lot sloping slightly west. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all steep slopes. 5. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. Mailing: P,O, Box 1807, Palmier, AK 99649 elf.' i`9i3ne: (907) 7 5-52��0 FAX: (907) 45-811- .y� On -Site Water anstewat REVIEWED FOR CO IE COMPL EAST 104TH AVENUE 33' BLM RESERVATION OSP181233, Deb erduss, 2i \ 10' T&E EASEMENT -77 i FUTURE WELL (P) -H LO Of FUTURE 4 BR HOUSE (p) r c) FUTURE SEPTIC AREA (P) LOT 14 w DRAIN FIELD (P) 75LF x 2.5'W x 7. O'E D x 1 1.0'TD WITH CO AND MT AT EACH END 1250g SEPTIC TANK (P) INSTALL FOUNDATION CLEAN OUT BEFORE AND DOUBLE CLEAN OUT AFTER TH-1 4 BR HOUSE (P) -77 PREVIOUSLY EXISTING HOUSE REMOVED, DRAIN FIELD E) • RE—USE AS RESERVE PREVIOUSLY EXISTING TANK I I _ REMOVED WELL (E) MARK WELL AND HOSE—BIBS 1 O ,, "FOR AGRICULTURAL USE ONLY" C). MAINTAIN PER 18 AAC 70 -Ar w WELL (P) � NOTES: PAMOM ENG SVC, LlC Date ti FOR CONSTRUCTION ...... �q�kj 8 2018 P.O. DVA WWI/ ANCHORAGE, AN JUDIV PHONE (907) 272-8218 FAX (907) 272-8211 co 49 m1"=50' f-- . . I", I I—AF, ...... ... .... ....... . j Steven . Pannone CE 8149 Idw k�j PROFE50" Scale T12N, RX Sec 15, LOT 14 LESTER & VICKI LEWIS 4400 E. 104th AVENUE ANCHORAGE, AK 99516 P.I.D. NO -015-112-27 PERMIT NO. OSP1 81233 PLAN Sheet 1 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS On-site Water and REVIEWED FOR CgOD,ECOMPI 1 CONSTRUCTION OCURRENT O ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENTPAR SAND MATERIALS USED I� ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65. 2. SCOPE OF WORK: INSTALL NEW 12508 SEPTIC TANK, AND SOIL ABSORPTION SYSTEM. INSTALL WELL 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 17 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 17 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4. THE CONTRACTOR SHALL HAVE ANY LOT LINE AND WELL RADIUS SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 5. THE CONTRACTOR IS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN THE ATTACHED. 6. THE CONTRACTOR SHALL CALL FOR LOCATING OF ALL BURIED UTILITIES. 7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS. 9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 10. THE CONTRACTOR SHALL SIGN THE FOLLOWING: I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: ME DATE: DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250 PERC RATE: 18.2 MPI SOIL RATING: 0.6 GPD/SF AREA RQD: 1000 SF SYS. TYPE: DEEP TRENCH 7.0'ED MIN LENGTH: 71.4 LF USE: 75 LFx2.5'Wx7.0' E.D., 11.0' TD TOTAL AREA: 1050 SF TITLE: LEGEND W WATERLINE/ WELL RADIUS SS NEW SEPTIC CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE FF FINISH FLOOR TS&V TOPSOIL AND VEGETATE NIC NOT IN CONTRACT NOTES: PAMONE ENG WC, LLC�F P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 q`�''k ,'C� 9�n��) � //�•�P yf� *: • H .r . ..... :. eve... ..... , .. Steven R. Pannone / /PERMIT �F CE 8149 ,� �� �s�.� !i �'Fp NP�F,® �`� OFE$512111 .- Date 8/2ot8 FOR CONSTRUCTION Scale NTS T1 2N, RX Sec 15, LOT 14 LESTER & VICKI LEWIS 4400 E. 104th AVENUE ANCHORAGE, AK 99516 P.I.D. NO 15-112-27 N0. OSPt 81233 DESIGN DETAILS Sheet 2 OF 3 10 11 12 13 14 15 16 17 BOH DATE PERFORMED: 6/8/18 SOILS LOG - PERCOLATION TEST SLOPE x TH OFCK M 4 BR �.� HOUSE /� Municipality of Anchorage (ln_cita \�/atar and 111/acta�nia REVIEWED FOR CODE COMP SITE PPE P181233, Deb Mckrr T' I t WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY DEPTH TO WATER AFTER MONITORING? -DRY DATE: 6/18/18 SLOPE TH x READING DATE TEST HOLE 1 NET TIME WATERTIME LEVEL READING OR ORGANICS 1 --- 4.44 --- 2 11:40 30 MIN 6.14 1.70 3 11:40 --- 4.44 --- 4 12:10 30 MIN 6.11 1.67 5 12:10 -- 4.44 --- 6 12:40 30 MIN 6.09 1.65 7 8 9 SM/ SILTY TO FINE SW SAND 10 11 12 13 14 15 16 17 BOH DATE PERFORMED: 6/8/18 SOILS LOG - PERCOLATION TEST SLOPE x TH OFCK M 4 BR �.� HOUSE /� Municipality of Anchorage (ln_cita \�/atar and 111/acta�nia REVIEWED FOR CODE COMP SITE PPE P181233, Deb Mckrr T' I t WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY DEPTH TO WATER AFTER MONITORING? -DRY DATE: 6/18/18 SLOPE TH x READING DATE CLOCK NET TIME WATERTIME LEVEL READING NET DROP 1 6/8/18 11:10 --- 4.44 --- 2 11:40 30 MIN 6.14 1.70 3 11:40 --- 4.44 --- 4 12:10 30 MIN 6.11 1.67 5 12:10 -- 4.44 --- 6 12:40 30 MIN 6.09 1.65 PEROLATION RATE 18.2 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 4 FT AND 5 FT COMMENTS: Test hole excavated by ISAAC'S EXCAVATING SERVICE. Prec hole was presoaked. Test run for at least one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL�G�UTIDLLITN�ES IN TE�^FFECcT ON TTTHE�DATE OF THIS TEST. NOTES: te PANNONE ENG SVC, LLC ►"SOF At-, Ak 8aj /2018 FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510 '� qS �� Scale PHONE (907) 272-8218 FAX (907) 272-8211 j * •49 M *�j� NTS P.I.D. NO T1 2N, RX Sec 15, LOT 14 LESTER & VICKI LEWIS Steven R. Pannone PERMIT NO. ��s CE 8149 r// 4400 E. 104th AVENUE � OSP181233 SOILS LOG ANCHORAGE, AK 99516il�Fp' P��= Sheet 11 �0�ss�oN Fnom: Lester Lewis Sub,pect. Existing Well Data: August 15, 2018 at 6:40 I'M ,o: Lee Nieman hand'v"';onstr'ud RE: Existing Well 4400 104th Ave Easli Ij*vzMIIVWV= The existing well recently tested to only 4.5 gal/min flow rate. Prior flow rate was recorded to be 16.5 gal/min. There has been much clay/iron sediment in the old well water. Therefore, we plan to place a new well for the new family dwelling. We wish to keep the old well functioning for daily use for landscaping, large garden, green house, horse stable, and large shop, separate from the new well and water system for the new family dwelling. We do not want to decommission the old well since we will not know for some time the flow rate and water quality of a new well. Also we would prefer to keep the two water systems separated FZWST!.�� On -Site Water & Wastewater System Permit Permit Number: OSP161358 Tax Code Number: 01511227000 ip�cn( MUNICIPALITY OF ANCHORAGE = ' Development Services Department n On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650—"�"` Department Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Work Type: WellSeptic Renewal Permit Effective Dates: January 12, 2017 to January 12, 2018 Design Engineer: PANNONE ENGINEERING SERVICES Subdivision: T12N R3W SEC 15 Site Legal Address: T12N R3W SEC 15 LT 14 G:2536 Owner/Address: LEWIS LESTER & VICKI 9821 SPRING HILL DR ANCHORAGE AK 995070000 Site Mailing Address: 4400 E 104TH AVE, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank All construction must be in accordance with: Lot Size in Sq Ft: 206745 Total Bedrooms: 4 N Privy Y Private Well N Water Storage 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 must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Special Provisions: Advisory - This lot will have to be subdivided in order to build the proposed second house that this permit's on-site systems is intended to serve. This will need to be addressed through Land Use Plan Review. No response required for this permit. Received Issued By By: Date: t7 %A -%%--A Date: 02 ho17 MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program's ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-112-27 Lester &Vicki Lewis \6\ woo o a Property owner(s) Day phone Mailino address 9821 Spring Hill Dr. Anchorage, AK 99507 n ;; Site address 4400 E. 104th Ave. Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T12N, R3W, Sec 15, Lot 14 Lot Size 206,745 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (2 all that apply) Absorption Field ❑x Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑x Upgrade ❑ Duplex (D) ❑ Holding Tank ❑ Renewal ❑X Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑x Water Storage ❑ - THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. property owner or authorized a Permit/Rush Fees: �Ww no ,ee) Date of Payment: —' Receipt Number: Permit No. Permit App_-.:- : Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panenRak.com December 23, 2016 Subject: Expired On -Site Water and Wastewater Permit Permit Renewal Request Permit Number: OSP151389 Legal Description: T12N R3W Sec 15 L14 This is a request to renew the permit for the above mentioned lot. All site conditions remain the same. The construction still will not affect the health, safety, or development of the surrounding lots. . Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 On -Site Water & Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151389 Tax Code Number: 01511227000 Work Type: Welseptic Initial Permit Effective Dates: December 30, 2015 to December 29, 2016 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: T12N R3W SEC 15 Site Legal Address: T1 2N R3W SEC 15 LT 14 G:2536 Owner/Address: LEWIS LESTER & VICKI 9821 SPRING HILL DR ANCHORAGE AK 995070000 Site Mailing Address: 4400 E 104TH AVE, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank Lot Size in Sq Ft: 206745 Total Bedrooms: 4 N Privy Y Private Well N Water Storage 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Receive Issued M MUNICIPALITY OF ANCHORAGE 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. Q151 -1,11-Z--,27 Property owner(s) Lester & Vicki Lewis Mailing address 9821 Spring Hill Drive, Anchorage, AK 99507 Day phone Site address 4400 E. 104th Avenue Legal description (Sub'd., Block & Lot) Legal description (Township, Range & Section) T12N, R3W, Section 15, Lot 14 Lot Size 206,745 Sq. Ft. Number of Bedrooms 4 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑X Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑X Upgrade ❑ Duplex (D) ❑ Holding Tank ElRenewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑X Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes: (Signature of property owner or Permit/Rush Fees: 969 + 215 = '7N Waiver Fees: Date of Payment: io-11ts/ 16 Date of Payment: Receipt Number: Oo`�5$) rn Receipt Number: Permit No. 05P15135m Waiver No. Permit App_? :-:L.:c; Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@i)anenzak.com December 14, 2015 Subject: T12N, R3W, Sec 15, Lot 14 Well and Septic System Permit Request Design Narrative This is a design narrative for a permit to install a new well and septic system to be issued for this property. The proposed systems will serve a proposed four bedroom (4) bedroom house. Currently the lot is developed with a house, including well and septic on the southern half of the lot. This lot and the surrounding lots are served by private wells. The well on this lot and the surrounding wells are over 100' from the septic system. 1. Soils. One test hole was performed on this lot by PES in October of 2015, and groundwater was monitored for at least seven days. Ground water was not observed to a depth of 18.0' below the surface in the test hole monitor tube after the 7 day monitoring period. Bedrock was not encountered in the test hole. Based on the results of the percolation tests and overall soils appearance; an application rate of 0.8 gallons/day/square feet was used for a conventional wastewater system in the area of the test hole. 2. Soil Absorption System Design. a. See Sheet 1 of the design package. 3. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain.field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 4. Topography: The existing topography generally slopes from the north to the south in the area surrounding the septic system at approximately 5% with a low area in the central portion of the lot sloping slightly west. There are no steep slopes within 50' of the proposed drain field. The proposed drain field will maintain 50' separation all steep slopes. 5. Drawing Markings: The Drawings are marked "For MoA Review Only'. When written notification that the review is complete and that there are no further comments is received from MoA On -Site Department, the note will be removed and "Issued for Construction" drawings will be issued. The proposed installation will not affect the future development of this or the surrounding lots. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 SEPTIC AREA (E) WELL AND SEPTIC 200'+ SEPARATION _�M —� y EAST \ l � WELL (P) 104TH AVENUE 4 BR I HOUSE (P) 128. 1 W 10' T&E EASEMENT -r � +I w b\ N THI 16.0 r 'PRIMARY/ RESERVE -DRAIN FIELD (P) 50LF x 2.5'W x 8.0'ED x 12.0'TD WITH CO AND MT AT EACH END 12509 SEPTIC TANK (P) INSTALL FOUNDATION CLEAN OUT BEFORE AND DOUBLE CLEAN OUT AFTER LOT 14 SEPTIC AREA (E) 3 � C HOUSE (E) 1 NOTES: PANNONE ENG SVC, LLC FOR CONSTRUCTioN P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 T12N, R3W, Sec 15, LOT 14 LESTER & VICKI LEWIS 4400 E. 104th AVENUE PLAN ANCHORAGE, AK 99516 (� OF. Al •Ste � ar CE 8149 s . 2/30/2015 Scale 1"=50' P.I.D. NO 015-112-27 PERMIT NO. DSPXXXXxx Sheet 1 OF 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1 . ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS AND AND IN ACCORDANCE WITH AMC 15.65. _ 2. SCOPE OF WORK: INSTALL NEW 12509 SEPTIC TANK, AND SOIL ABSORPTION SYSTEM, INSTALL WELL - 3. GROUNDWATER WAS NOT ENCOUNTERED TO A DEPTH OF 18 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 18 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. 4. THE CONTRACTOR SHALL HAVE ANY LOT LINE AND WELL RADIUS -SHOWN ON THE PLAN WITHIN 30 FEET OF THE PROPOSED SYSTEM STAKED BY A REGISTERED LAND SURVEYOR BEFORE STARTING THE WORK. 5. THECONTRACTORIS RESPONSIBLE FOR ALL R.O.W. AND OTHER REQUIRED PERMITS, OTHER THAN. THE ATTACHED. 6. THE CONTRACTOR SHALL CALL- FOR LOCATING OF ALL BURIED UTILITIES. _ 7. THE CONTRACTOR SHALL PROVIDE 24 HOUR NOTICE TO THE ENGINEER PRIOR TO START OF WORK. ALL SURVEYING AND LOCATES SHALL BE IN PLACE PRIOR TO NOTIFYING THE ENGINEER. 8. THE CONTRACTOR SHALL NOTIFY THE ENGINEER OF ANY DISCREPANCY BETWEEN THE APPROVED DRAWINGS. 9. AT THE COMPLETION OF THE WORK, THE CONTRACTOR SHALL SUBMIT RED—LINE AS—BUILT DRAWINGS TO THE ENGINEER. THE RED—LINES SHALL INCLUDE PIPE LENGTHS, ORIGINAL GROUND ELEVATIONS, PIPE ELEVATIONS, AND TANK ELEVATIONS. 10. THE CONTRACTOR SHALL SIGN THE FOLLOWING: - I CERTIFY THAT ALL WORK WAS PERFORMED IN ACCORDANCE WITH THE APPEND PERMIT, AND ANY AND ALL CHANGE ORDERS, AND THAT THE AS—BUILT REDLINES ARE TRUE AND ACCURATE REPRESENTATION OF THE PROJECT AS CONSTRUCTED. CONTRACTOR: BY: TITLE: DATE: DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4 (600 gpd) TANK SIZE: 1250 PERC RATE: 14.4 MPI - SOIL RATING: 0.8 GPD/SF AREA ROD: 750 SF SYS. TYPE: DEEP TRENCH 8.0'ED MIN LENGTH: 46.9 LF USE: 50 LFx2.5'Wx8.O' E.D., 12.0' TD TOTAL AREA: 800 SF LEGEND W WATER LINE/ WELL RADIUS SS NEW SEPTIC NOTES: PANNONE ENG SVC, LLC FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 T12N, R3W, Sec 15, LOT 14 LESTER & VICKI LEWIS 4400 E. 104th AVENUE DESIGN DETAILS ANCHORAGE, AK 99516 mippMjjUA D1�� CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT N0. C# CLEAN OUT NO. M# MONITORTUBENO. R. 1. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BEG BELOW FINISH GRADE OG - ORIGINAL GRADE FG - FINISH FF _GRADE FINISH FLOOR TS&V TOPSOIL AND VEGETATE NIC NOT IN CONTRACT Date OF A�41 1h 12/3 CE 8149 NTS '.I.D. NO 015-112-27 2 OF 51 TEST HOLE OR ORGANICS 1 CLOCK NET TIME 2 NET DROP 1 10/15/15 3 --- 6.55 4 2- - +I 5 8.69 2.14 s 3:45 --- 7 4 BR 0 8 HOUSE 8.65 y SM/ SILTY TO FINE TH-1 - SW SAND 10 4:45 30 MIN 11 2.08 12 13 14 15 16 17 18 BOH DATE PERFORMED: 10115/15 SOILS LOG - PERCOLATION TEST SLOPE I '7\ SITE PLAN Z X TH WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? -DRY SY/ x DEPTH TO WATER AFTER MONITORING? -DRY _ DATE: 10/22/15 SLOPE TH x READING DATE CLOCK NET TIME 10' T&E EASEMENT NET DROP 1 10/15/15 3:15 --- 6.55 -- 2- - +I 30 MIN 8.69 2.14 3 3:45 --- 6.55 4 BR 0 4:15 HOUSE 8.65 2.10 5 4:15 TH-1 - SY/ x DEPTH TO WATER AFTER MONITORING? -DRY _ DATE: 10/22/15 SLOPE TH x READING DATE CLOCK NET TIME WATERTIME LEVEL READING NET DROP 1 10/15/15 3:15 --- 6.55 -- 2- - 3:45 30 MIN 8.69 2.14 3 3:45 --- 6.55 --- 4 4:15 30 MIN 8.65 2.10 5 4:15 -- 6.55 -- 6 4:45 30 MIN 8.63 2.08 PEROLAT10N RATE 14.4 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 5 FT AND 6 FT COMMENTS: Test hole excavated by ISAAC'S EXCAVATING SERVICE. Prec hole was presoaked. Test run for at least one hour. Last 3 readings reported PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES: -PAM N EN _���� \\ Date FOR CONSTRUCTION P.O. �gpXOj0129 4 ANCHORAGE, �K 99510 �c�°F•A�gsli+ 2/30/2015 PHONE (907) 272-8218 FAX (907) 272-8211 Scale NTS .... ... ... P.I.D. NO T12N, R3W, Sec 15, LOT 14 ...... . . • . 615-112-27 LESTER & VICKI LEWIS Steven R. annone PERMIT NO. �F.•, CE 8149 j OSPXXXXXX 4400 E. 104th AVENUE+mss .� SOILS LOG ANCHORAGE, AK 99516 Sha et 3 01/23112013 21:47 9072430742 AWPS, 7NC. PAGE 01/ amu± IL P A r a, Ma k,9egich Mayer Pump Installation Log Well Drillinp, Permit Number: SW^ � Date of Issue: Parcel Identification Number: f.,egal [Description Property Owner rName 3 W Se, c,, is— Jrl`d� R ley k^r- 1.. r UMV auaLxuauun mace: I, _ '-L 3 , 1 Pump rutakt Depth Dtluw Top of well Ca: Pump Nlanufaeturer's Name: tqx/ rV Pump Model: V 7 7 5 Pump Size �k tap Pitless Adapter Burial Depth: (, feat Ndess Adapter Manufacturer's name: eYi ladtieSS .=x:ute�7 t9? 2awajler: A)4 Well DiAnteeted Upon itf<athQd of D15tMectioa: Commelits: Pump Installer [Mame. Attemloa: —Me pump installer Shall provide a p: 11/6 feet Pump & Well Sere :330 East 76th Avenue Anchorage, Alaska 99si3 Phone: 907-243-0740 Fax: 907-243-0742 ip instaltatioa log to the DSD within 30 days of puxmp irs:allati on, MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN 13ERVICES Environmental Health Division 2 2 f 825 " L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT DISTANCES TO SEPTIC ABSORPTION �- - FROM WELL 4t9Z� L _fANK —FIELD Pnonels) F¢mutN°, WELL lUj' No of getlroams IJ LEGAL DESCPIPTION LOT LINE LotBlock Subdimston---— I�ZL 9- I FOUNDATION �/ Township, flange. Section �— / L�3' --_ � I AS -QUILT -DIAGRAM IShow location of wen, septic sysmm, properly lines. foundation. I REMARKS: =Caddy that Municipal and State, Indiana in affect ,00nnntthis data Health Department Approval: 72-013 (3/85) -I.— I. • a YOB r ENGINEERS SEAL `- inspections Performed by. / � y/� �J /✓inti.— speclion w erlormetl accnrlling to all Dale:LP=21=170 t ..:.J. _ TANKS ---- SEPTIC ❑ HOLDING --/-- Manulaccl�l.j.. er Capaaly In gallons --- ,LSI& "LZ �. __ 9 0 _ No of Compartments Maten.d zj TYPE OF SYSTEM �fRENCH i ❑ BED ❑ W. DRAIN ❑ OTHER ---- Depth to pipe Uouom h---om ) 7rule depth from ong nal grade onginal yratle ///� I'::)_/0 FII add¢d shore onq,nal gratle _FT Gravel depth beneath pipe --— — Ff FT Gravel lenglli Gravel width fr l3FT FT To121 absorption area / 60 SOFT Distance beiwden Imes es -- FT Nunmcroiau Son ,ming Pipe malenal I --(__]_ 1i0� SOFT Installer -A —3 � v D01¢ Inalall¢tl WELLS ❑ PRIVATE ❑ OTHER (Identifv) Classilicao oton cy—.B CI^ ------ Total Uepih Gased to Inseauei — Date Instaed FT I REMARKS: =Caddy that Municipal and State, Indiana in affect ,00nnntthis data Health Department Approval: 72-013 (3/85) -I.— I. • a YOB r ENGINEERS SEAL `- inspections Performed by. / � y/� �J /✓inti.— speclion w erlormetl accnrlling to all Dale:LP=21=170 t ..:.J. kb'�'�/\ '.��' MVNlC1PAL1[Y VF ANCHOR�8E Uepa/�Lme'�� �� !' �!�^ !Wan Services B25 L St/`eet, Ancho,a4e, Alaska 9950l J43 1���J�u�K\ [ANK /'�RMIT 8801YO Upqvade 09/15/88 Engineer Designed Owner Name: JIM RYAN Own'` �'�|'~`�� 440O E. 14q AyE Day P|'une: , ANCHORAGE, MK 99516 346-1663 Par,el 11: �]5 |/, �-ql�/ |ot Legal: Subdivision: / W , Gluck: - Section: 15 Township: 12N Range: 3W SEC LOT 14 io( Size 3 A (sq"I or acres) ;h ")OMEN lk1s Permit: 4 Total Capacity: 4 |W : Minimum total septic tank capacity: 1v250 gallons" Each septic at least 2 compartments, Depth to Lop of septic tank(s) < 4.0 I'd (;11 over Lank(s>" DESIGN [N6TALL A TKFNCH 55' LUNG; a' 8RAoEL DWIM; �U>01 oE/ N01!1 / 1AX|1!:.; PKlIII [O NSP��|ION. K /; PI. k^|/` |: HS�;||1: 1) 1 O o �.|/`^^ |;|LY kL''|/xu' / /'|! Y ?NU EXPIRES 12/31/88. l ��EK|1FY THA|: 1 1 am [aw.|� , ./ requirements !or on-siLe sewers and wells as set iorth by the Munic1pal1ty of Anchorage (MOA> and the Si"t" o| Alaska 2 [ will install the sysium in accordance with aii MOA codes and ,egul�utions and in compliance with the desiqn criteria of this permit ' J" 1/will adhere to all MOM and Sta�e of Alaska requirements for the seL back ' !^nres from any existing well, wastewater disposal system or p.�blic ' :~ ~',1',: o/. this or any adjacent or nearby lot 4. l understand that this permit is valid (or a maximum �of ,� 4 beroums I a1s., xnde/=iand !hat Lhw capacity of the total systemis 4 bedrooms � and any enlargement will require an additional permit. —- ' DATE: (ENGINEER'S SEAL) • Municipality of Anchorage t DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOC m- PERCOLATION TEST PERFORMED DATE PERFORMEDi�,/i —_ LEGAL DESCRIPTION:lw � S� —"— Township, Range, Section: a, � 'T= SLOPE crrG m 0V67��N I C r> 1 z 3 fl " 4 5 I' o 01 6 XA ��w�.XA A4 al_ � k�F 8 e , Net Drop - 10- c A J 11 - AU 9 i;- 4` ! i Z 12 � v 13 14 �3tl'i i o N v 15 16 17 18 19 20 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? Depth 10 Wale- Alto hle r _/ MonitorinA9 — / Date: D Reeding Date Gross Net Depth to Time Time Water Net Drop - -5 ¢ y — AU 9 i;- 30 'i 30 i Z �J PERCOLATION RATE IQ _ (minulesnn/ch) P RC HOLE DIAMETER TEST RUN BETWEEN � FT AND JL `2 --FT COMMENTS PERFORMED BY: ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN 72-008 (Rev. 4/85) "W CERTIFY THAT THIS TEST WAS PERFORMED IN ON THIS DATE. DATE _ , I �h�_ Tobben Spurkland P.E. RYA Pel qyo-o I u 167 NI SO I L. hr 1 I AI S ; ` 14" -••�'w"�'�n.�nnw.n:waw�w..a»:w-a�aa+w.rs�+:•.H. of A6.50 r �2. �. .a .. MUM i N2225-1:�Oil Tobben Spurkland P.E. I VVI ` < / Q Vi ao L= 1 C)1-1 AdAvie- -- L/\y o i Ii1- 301 jm C. G'%ISY - TA NW /' n lot 4p a IV1s[aW SloPlt O, U �iJY lig r .. l' 1�0 , , is Certified Well r I tcertify the above true and correct. .. nq'' k" t int n,) rC, l ROTTEN DRILLING CO, )ohri's Road Q 1 n = o GG SPENARD, ALASKA b We advise you to attach this certificate to your deed. �f ' � y � P m» imbw 1C42) I UNITED STATES DEPARTMENT OF THE INTERIOR GEOLOGICAL SURVEY WAIT= RESOURCES DIVISION �Q WUL LOG e-, /9s State County Subarea Ido. /e—ej Location...12x Drilled by To h n L,r aX Address Date Casing diam. °' pr M �d Land -surf. alt. Source of data _ (Esher We of A Perforations. Yield, and drawdown at end of loo) Co �aoar , THimms (feet) DEPM (feet) --------------------------- _- -- 3 P-----1 AS el & a/ -Sir _d--- _ �.3 0 73 • __ L4.��.sln�- -1--- '2' .6 l�. is S-� r�oc,�s , ►t ¢ cra v���_�rlutt� �r�--------- _ l Lr. -A _.�S - - t-1--�� ' T•f.. Rev BY f Smr --- OF a S. 40meen mints" mm ;b—pipe?-3 Parcel I.D. Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 Aup APR 2 2 2015 CERTIFICATE OF ON-SITE SYSTEMS APPROV-At. �i!!e 015-112-27 1. GENERAL INFORMATION Complete legal description Location (site address) Current Property owner(s) Mailing address Real Estate Agent 2. TYPE OF DWELLING: Expiration Date: �3 J 1 — T12N, R3W,19ECTION 15; LOT 14 4400 E. 104TH AVENUE, ANCHORAGE, AK, 99516 PAULETTE RYAN Day phone 16001 WIND SONG DRIVE, ANCHORAGE, AK, 99516 BRIAN BRODERICK W/ JACK WHITE Day phone 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 202-3966 273-7261 3. NUMBER OF BEDROOMS: 4 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site 0 Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: NIA ( SEE ATTACHED LETTER) Distance: Received by: I Date: �� c COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 5a� Date of Payment Ll'a2311� Receipt Number Q R ©t7 COSA# Of) U5-11 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, t 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. t 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 Address GARNESS ENGINEERING GROUP, Ltd. 3701 E. TUDOR ROAD, SUITE 101 " ANCHORAGE, AK, 99507 Engineer's Printed Name Engineer's Comments: JEFFREY A. GARNESS, P.E. In conducting this evaluation, GEG provided an engineering evaluation of the well andfor septic system in accordance with the guidelines and regulations established by the Municipally of Anchorage and indusfryprecfices. The reported results describe the condition of the systemk on the datelia of the evaluation. Separation distances were measured To readily idenfdmble features. Hidden defeds or encroachments may exist that were not identified during the evaluation. The operational life of all wets and septic systems depend on a varietyof variables induding, but not limited to, soil conditions, groundwaterievels (that may fluctuate during the year), quality ofconstrudion (materials and workmanship), and the water usage of the family utilizing the systems. These conditions can vary, and are outside the central of GEG. Satisfactory test results do not guarantee future performance of the systems therefore, GEG makes no warranty (express or implied) regarding the future performance of the welt or septic system. GEG makes no miamentalion whether an alternative well or septic system can be installed on the property in the event either of the cement systems fail. The content of this report is for the sole benefit of the persoolpady who retained GEG. Reliance upon the information provided in this report by any other person orparty, including but not limited to subsequent pmpedypumhasers, is not authorized. In short, GEG disavows any legal duty to anyone other than the person party who paid for This report. 6. DSD SIGNATURE System #1 Approved for `T bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date N ZD It bedrooms, with the following stipulations: yes OF IV6't ; J ON-SITE WATER AND =o WASTEWATER %_. PROGRAM Original Certificate Date: / "- t S The lvieficip iairage Devetop,emt Services Division (DSO) issues Certificates of On -Site Systems Approval (COSA) based only upon the rep resena aeons 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. 7. ATTCHMENTS: COSA Checklist Nitrate Advisory" Septic System Advisory Arsenic Advisory Well Flow Advisory Other (Rev.MUM) If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: T1 2N, R3W, SECTION 15; LOT 14 Parcel ID: 015-112-27 A. WELL DATA *ASSUMED BASED UPON SURROUNDING WELL LOGS. **SEE ATTACHED LETTER. Well type PRIVATE If A, B, or C provide PWSID# N/A Date completed 12/15/1967 Sanitary seal (YIN) YES Total depth 195 ft. Cased to *40+ ft. FROM WELL LOG Date of test 12/15/1967 Static water level 162 ft. Well Log (YIN) Wires properly protected (Y/N) YES Casing height (above ground) ** in. AT INSPECTION Well production 12 g.p.m. _ WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml.. Nitrate 0.152 mg./L. Arsenic: ND ug./L. Date of sample: 3/1 212 01 5 B. SEPTICIHOLDING TANK DATA *INSIDE BASEMENT Tank Type/Material SEPTIC/STEEL Tank size 1250 gal. Number of Compartments 2 3/12/2015 160 4.9+ Collected by: GEG, Ltd. Date installed 10/14/1988 Cieanouts (Y/N) YES Foundation cleanout (Y/N) *YES Depression over tank (Y/N) NO High water alarm (YIN) N/A Date of. pumping 3/2612015 Pumper ONE STOP PUMPING C. ABSORPTION FIELD DATA BELOW EXISTING GRADE Date installed 10114/1988 Soil rating (g.p.d./ftlbrqfbdrm 165 System type TRENCH Length 55 ft. Width 1.5 ft. Gravel below pipe ,.6 ft. Total depth *10.4 ft. Eff. absorption area 660 ft2 Monitoring tube YES Depressioh over field NO Date.9f adequacy test **311312015 Results (Pass/Fail) PASS For 4 bedrooms Fluid depth in'absorption field before test 36 in. Water added 940 gal.New depth 70 in. Elapsed Time: 720 min. Final fluid depth56 in. Absorption rate >= 600+ g,p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date - **HOUSE WAS VACANT AT TIME OF TEST. DRAINFIELD WAS PRE-SOAKED ON 3/1212015 WITH 2000 GALLONS OF WATER. D. LIFT STATION Date installed Size in gallons Manhole/Access "Pump on" level at in. "Pump ofP' level at wa er alarm level Cycles tested Meets alarm & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO Septic tank/lift station on lot 1001+ On adjacent lots 100'+ Absorption field on lot 100'+ On adjacent lots 1001+ Public sewer main NIA Public sewer manhole/cleanout N/A Sewer /septic service line 254 Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Building foundation 51+ Property line g+ Absorption field *UNKNOWN Water main N/A Water service line 10'+ Surface water, 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 101+ Water main N/A Water service line 10'+ Surface water **UNKNOWN Driveway, parking/vehicle storage Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS *UNSPECIFIED ON INSPECTION REPORT. 4'3" FROM TANK CLEANOUT TO POST TANK CLEANOUT. **SEE ATTACHED LETTER REGARDING MISSING CLEANOUT & POTENTIAL SURFACE WATER ON NEIGHBORING LOT. G. ENGINEER'S CERTIFICATION I c6i$fy that t have determined through field inspections and revigW of Municipal records that the above systems are in corl(drmance with MOA COSA guidelines in effectgn this date. Engineer's Printed Name JEFFREY A. GARNESS Date (Rev.10/12112) if . R EAST 1091h AVENUE w 13 w o O 94. O Mr T N50-57'00rW 3298S f jr- UNDER NO CIRCUMSTANCES SHOULD AN AS -BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL UARIUTY ONLY FOR THE COST OF THE SURVEY. LISTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE. OT SURI£Y SURVEY TYPE SYMBOLS ❑ FWNaATCN A9-BUa.i SET REBAR pRAWAGE ASPHALT C1 ONAL STalIC1 K AS -BUILT O FOUND R£BAR 0 0 8 . WOOD FENCE '""6 �"" CONCRETE ❑ PLaT PLAN ... AS -BUILT ... WT WW ... iCPaGUAPHY _ 600 4) ASSUMED ELEV. .X It X METAL FENCE ® WOOD DECK IT IS THE RESPONSIBILITY OF THE CONSTRUCTION, TO VERIFY PROP( TO FINISHED GRACE AND UTILITY C THE EXISTENCE OF ANY EASEMENT WHICH DO NOT APPEAR ON THE SURVEY CERTIFICATION PLOT PLAN FOUNDATION AS -BUILT �xwr•r x, nwr+wr a.l 1 MBUM vMY d M a.wuel m x.w w w ewe a w. anmwe•• ma k4mvan a e,ow, eA.sn �. FINAL STRUCTURE AS -BUILT BUILDER OR OWNER, PRIOR TO ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE SED BUILDING GRADE RELATIVE: SHOWN. FENCES, WELLS, SEPTIC CLEANOUTS, SIDEWALKS, DRIVEWAYS, )NNECTIONS AND TO DETERMINE ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW COVENANTS OR RESTRICTIONS MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED. RECORDED SUBDIVISION PLAT. ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED. Lu Prepared by Robert E. Johns, Jr. & Assoc. Professional Land Surveyors 1700 Brink Drive. ANCHORAGE. ALASKA 99504 ,.ale. 1,I = 1001 Ree. Lot S.F. Rec. Plat File No. `5' I. Or Dale Surve d: Drawn" � ookea JMK .....� �` 03/10115 REJ J5 ROBERT I .JOHNS •JR„• t o Dat® Dtawn: Grid: W.O. 4121—S ;' ;_N„ 03/11/15 2536 15-79 '• < ♦ Legal DescrlPtion: S� . :_° a,ee;; gat X01:6 T1 2N R3W SEC 15 LOT 14 GARNESS ENGINEERING GROUP, Ltd CIVIL & ENVIRONMENTAL ENGINEERS April 20, 2015 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road, Anchorage, Ak 99519-6650 (907)343-7904 REFERENCE: Surface Water Distance and Pit Well for T12N, R3 W, Section 15, Lot 14. To whom it may concern, The subject property is served by a private well and a septic system consisting of a 1250 gallon septic tank and a trench type drainfield. During our inspection, some potential deficiencies were identified but they do not appear to require a waiver. WELL: The well is level located inside a concrete pit with a watertight lid. The well head itself does not extend above grade, but it does extend approximately 8 feet above the bottom of the pit. We request that you approve the well in this current condition. The following items are justification for this: • The well was approved in this configuration on 11/15/1988 by your department. • Examination of the well pit did not reveal any apparent evidence of water building up inside the pit. • We directed the owner to have the lid re -built out of weather resistant materials and properly waterproofed and they have. Pictures were submitted to Jay Crewdson, P.E. on 4/16/2015. • The wiring inside the pit was encased in protective conduit by Aarow Pump and Well Services (see attached receipt). DRAINFIELD AND SURFACE WATER: The inspection report shows a cleanout on both ends of the drainfield. During inspection, the cleanout at the east end of the trench could not be located. Cleanout access is still possible through the post tank cleanout. A large amount of frozen water was noted on the neighboring property to the east. Because the east cleanout was missing, the exact separation distance could not be identified, but it appears to be over 100 feet. It is also not certain if the ice represents a permanent surface water or if it is just a collection of runoff that has frozen during this year's winter conditions. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338.3246 * Website: www.gamessengineering.com Page 2 of Jeff Poet with the M.O.A. was contacted and met us on-site to examine the aforementioned issues on 3/12/2015. Also, the water was inspected again on 4/17/2015 and it appeared to not be a permanent surface water. Pictures from the 4/17/2015 site visit are attached. If you have any questions, please contact us at 337-6179. Sincerely, P.E., M.S. 3701 East Tudor Road, Suite 101 *Anchorage, Alaska 99507-1259 Phone: (907) 337.6179 * Fax: (907) 338-3246 * Website: www. gamessengineering.com DL,) v, el Of�Gu) C, c C,�9-5r-5. Municipality of Anchorage P.O Box 196550 4700 Elmore Road Anchorage, Alaska 99519-6650 (907) 343-7904 Fax (907) 343-7997 http://www. m u ni.org/onsite Planning and Development Services Department On -Site Water and Wastewater Program On -Site Sewer/Well Submittal Comment Sheet -Engineer: GARNESS ENGINEERING GROUP LTD .egal Description: TI 2N R3W SEC 15 LOT 14 3ermit: OSC151169 WellSeptic Completed By: Report Type: COSA -he attached paperwork has been reviewed and is being returned for the following reasons: 4/28/2015 J.Poet From 1986 a cleanout is required at both ends of a trench. _ � J Qy aW�. � 94— AAROW PUMP & WE« SEROCEp LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 • Fax (907) 345-0202 Eagle River: (907) 622-9335 Fes} F ...... _... _.. No. 10393 JOB SITE L loel�Z4,imlfmw ICiE.t] E `VELA. DEPTH SWL CHLORINATED PUMP DEPTH SALESPERSON i}lg _ . " .._ R#F*'CiON - -,-._, .. . , .,.. PRICE AMOUNT Of LABOR HOURS RATE AMOUNT TOTAL MATERIAL r— TOTAL LABOR ORK ORDERED BY TOTAL LABOR PAY THIS AMOUNT f SIGNATURE Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aaro Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment.) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.516 PER MONTH WILL BE CHARGED ON OVERDUE. ACCOUNTS. Eagle Building Services Inc. 2525 Blueberry Road Suite 105 Anchorage, AK 99503 907-277-6356 ENL 92-0138513 Contractor's License: 21550 Bill To Prudential Jack White Vista Real Estate 3801 Centerpoint Drive, Suite 200 Anchorage, AK 99503 W.O. No. Invoice Date Invoice # 4/17/15 15-4210 Terms ( Project 4400 East 104th Quantity I Description I Amount 31 Labor: Took the old well cap off to use as template. Built new well cap with pressure treated lumber to the same dimensions as the old cap. Covered the cap with roofing membrane and insulated the cap with 2" rigid foam. Put the cap back on the well box and covered the cap with a Mansard Brown sheet metal cap. Materials: 1 1 sheet of 2" rigid foam insulation and 2 tubes of foam board glue. I I ea. 31 1/2" x 31 1/2" Mansard Brown well cap cover. 135.00 47.90 140.00 MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services t DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ^^,, ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # (L1'f . 11 2 2_7 HAA # — til 9-N%— � L-� ��-- 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Property owner _ Ryam Telephone : (home) 3N6,-16la Business — Mailing Address (c) Lending Institution q0V lJ 10 Mailing Address (d) Real Estate Company and Agent — Address Telephone Telephone _ (e) Mail the HAA to the following address: (or check here if hold for pick up.) List contact person and day phone number below: 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 4- 3. WATER SUPPLY Individual Well V Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site K 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 (RBV. 7/88) Page 1 of 2 Z to Z abed aM (BOIL *IGH) szo-ZL )JOM s,aaaulbua leuolssaload ayl ul suolsslwoaosjoajaaolalglsuodsaaIOU sla6eaoyouyloAllledlolunwayl pansslsieleollllaaoeajolagLlepozAlLuejo suolloadsulion puoojou opSHHalosaa/oldw3 sluawailnbeialelspueleaapelulelaao/lsllesoliepioulsuoilnl!lsul 6ulpual alayl pue savoy to sjaseyoand of /salinoo a se slyl saop SHHG ayl Te sely to alelS ayl ul paaalsl69J aaaulbue leuolssaload luapuedepul ue Rq anoge g ydei6eied ul uanlb suoileluesaadej ayl uodn �Sluo paseq paleo!!!aao lenoaddy/l!joglny ylieaH sanssi (SHHQ) saolAaaS uewnH pue ylleaH to luewljedap a6eaoyouylo (llled lolun ' ayl leAoaddy leuollipuoo to swial leuoll!puoo panoaddesla panoidd y alep lgswoolpaq-17—aolpanaddy 7lVA0Hddtl SH HO '9 e f� •r` leaS s,aa8wbu3 _ b 1 1 / ° area ssaappy auoydalal ro1 A , S wa!d to aweN uopoadsui slyl to alep eql uo loalla ui suopulnbaa pue'seoueulp�o 'sepoo alelS pue ledlolunW lie gjIM aouellolldwoo ul sl wals/s lesodslp aaleMalseM ao/pue Alddns jaleM olls-u' ayl 'uoloadsul pue uolle6llsanul (w woal pue sal!j ebejoyouy to (illedunIN ayl woal pauielgl o uollewaolul ayl u i paseq leql (IJGA jeglanl ! •ulaaay peompul ainlonjls to acAl pue swooapaq to aagwnu ayl aol elenbape pue leuollounl ales sl wals(s lesodslp JaleMalseM ao/pue (lddns aaleM 9;!s-uo ayl legl sMoys lenoiddy Alljoylny ylleaH s!yl to uolle6llsanul (w leyl �l!�an l 'Molaq uMoys alep uo!lep!IeA ayl to se pue olaaay paxllle leas /w (q pa!!!ljao sy NOI1yWHOdNI ONy y1y0'HOHV3S 3-1Id'S1S31'SN01103dSNl `JNIOIAOad WHIA ONI833NION3 -9 / MUNICIPALITY OF ANCHORAGE (MOA) 0 A } • � � E` ? Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 iiii�!< Q 343-4744 Legal Description: -L-aT 'T- / �2 2 -?:, U'/ A. WELL DATA C0 Well Classification — (—' F If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed _ "//S- r5 / Yield /,2 Total Depth__L�5 Cased to /q-�_ Depth of Grouting Static Water Level TA Casing Height Above Ground Electrical Wiring in Conduit (Y/N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot 10 � Pump Set At R. ' f/o _ Sanitary Seal on Casing (Y/N) — Depression Around Wellhead (Y/N) 604cude 7�X On Adjoining Lots _ NQN� To Nearest Edge of Absorption Field on Lot / / :5 r ; On Adjoining Lots _ N C N E To Nearest Public Sewer Line N/A To Nearest Public Sewer Cleanout/Manhole�'ns To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed _ f 4_1 / %' 'Size 1960 No. of Compartments 1� Date it Standpipes (Y/N) _ T_ 1, o .—Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Y --- Depression — _ Depression over Tank (Y/N) Date Last Pumped Pumping/Maintenance Contact on File (Y/N) -- ; for NIA -- Holding Tank High -Water Alarm (Y/N) - t"/IA Temporary Holding Tank Permit (Y/N) N�A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 1 ? f To Building Foundation To Property Line Ir To Water Main/Service Line > 10 To Stream, Pond, Lake or Major Drainage Course Comments To Disposal Field 72-026 (Rev. 7188) FmN Page 1 of 2 tom( v rtC- 7 i-1 C. ABSORPTION FIELD DATA Soils Rating in Absorptii n St ata �5 Type of System Design 2 NClk Date Installed f / y /�e'l1Jl Length of Field 5 � Width of Field .2N / Depth of Field 10 Gravel Bed Thickness h Square Feet of Absortion Area la &0 Statndpipes Present (Y/N) 3 Depression over Field (Y/N) N Date of Last Adequacy Test �+ 4 Results of Last Adequacy Test V–Ar SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well To Property Line r; fi To Building Foundation ( _ To Existing or Abandoned System on Lot -7 Z% ; On Adjoining Lots No NL To Water Main/Service Line >/O To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION N D N t_,– Date Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments i Dimensions Manhole/Access (Y/N) "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. "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. Signed Companyi 0(alo-e" SeufVAaIAA� P). Date — I' (/ R o %' Engineer's Seal MOA No. Receipt No. Date of Payment Amount: $ 72-026 (Rev7/88) Rack V1C�L-�C> — Receipt No. — Waiver Fee: $ - - Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAC' DEPARTM r OF HEALTH AND ENVIRONMEJ L PROTECTION u 82!5�L Street, Anchor.aap., AlKska 99501 264-472,0 Date Received: January 13,-1978 $1: Time _2:30 P.M. #2: Time _L( f #3: Time Date 1-16-78 Monday Date Date Insp Pratt. Insp P12 4 77- Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: In?x o-f—Anolacerage Mailing Address: -go —Phone: 2. Property Owner: James M. Ryan Phone: 344-1692 Mailing Address: Star Route A Box 1731 99507 3. Legal Description: T12N R3W-Section 15 Lot 7.4 4: Single Family Residences (x) Number of Bedrooms: Four Multiple FamilyResidence: { ) Number. of Bedrooms: 5. Well System: Individual Well (x) Community/Public System'( ) Permit It Depth of Well 190' Well Log on File ( ) Construction Bacterial Analysis 6. Sewage Disposal System: On-site System (x) Public Utility ( j Permit It Installed 19561 Installer Septic Tank Size Manufacturer Absorption Area Soils Rate 7. Distances: Well to Septic Tank to Sewer Line Nearest Lot line Material to Absorption Area Absorption Area Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal. Description: T12NNRR3W Section 15 Lot 14,—_ i Comments: ---- ----- MUNICIPALITY OF ANCIIORAGL 9, Department of Health and Environmental Protection 825 L Street, Anchorage, Alaska 9950'L264 -4720 950'L 264-4720_0 =ri�quest for Approval of Individual Sewer and Water Facilities !f 1. Property Owner: Jj/5 �LJpL«------------------- -- Mailing Address: S �_la����3 ALN. Phonc:3��-i6`l2 2. Name of Buyer:\�`�-`Aldrnc�G---------------._ Mailing Address: ______ Phone: 3. Lending Institution: /57- O14-VU/,(4z- 44Q1' - Mailing Address: 5d(/77� 4,,V41'✓cu/— Phone: d. Realtor/Agent: Mailing Address: —__—_ Picone: -- 5. Legal Description: Street Location: 6. Single Family Residence: ((G) Number of Bedrooms: L -{- Multiple: Family Residence: ( ) Number. of Bedrooms: 7. Water Supply: *Individual Well. (Y,) Public/Community System ( ) If Individual Well, well depth / qeq [-(— if Community System, name of system 8. Sewage Disposal System: *ADn-site System (/C) Public System ( ) If On-site System, date of installation /d.� 4'^ 19 5'-& *NOTE: A well log is required on ALL wells drilled since 6/75. * if on-site sewer system is over two(2) years old, an adequacy Lest is required by this department. A fee of $25.00 must accompany each request before processi-ng can be initiated. 3/77