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Home My WebLink AboutWOODRIDGE BLK 1 LT 3Onsite File r � r inspection Repori__ i- i- i 2.aoc Municipality of Anchorage Community Development Department Page I of 2 On-Site Water and Wastewater Program 4700 Elmore St.. P.O. Box 196650 Anchorage, AK 99519-6650 - http://www.muni.org/onsite - (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP1 71225 PID Number: 020-093-06 El New [Z] Upgrade Name: CAROL FRIES ABSORPTION FIELD El Deep Trench El Shallow Trench ❑ Bed E] Mound Address 16641 VIRGO AVE. [:] Other Phone Number of Bedrooms Soil Rating depth from original grade 3 ITotal GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Ft. Gravel depth beneath pipe Ft. Subdivision Block Lot WOODRIDGE 1 Fill added above original grade Ft. Gravel length FL Township Range Section Gravel width FL Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To' Septic AbsorptionHolding 1 Sevier Total absorption area Number of trenches Dist. between trenches Lift Station; From Tank Field Tank Line Ft' Ft. Well 104.5 N/A N/A N/A NIA TANK ED Septic [I S.T.E.P, El Holding n Other Manufacturer GREER Capacity 1250G,I. Surface Water 100+ N/A N/A N/A Material Number of compartments Lot Line 22.3 N/A N/A NIA HDPE 2 NA Foundation E 5.0 NIA I N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 1 50+ N/A N/A N/A Gal. Remarks Pump on level at Pump off level t--- in.. High water alarm at in. Purnp make model Electrical Inspections performed by Installer PIPE MATERIAL Housetotank 3034 Tank to 3034 drainfield A+ HOME SERVICES Drainfield CO/MT jo Inspector PANNONE ENGINEERING SERVICES BENCH MARK (Assurned elevation) 527.Oft Inspection dates: j 6/5/18 2'd 10/19/18 Location and description 3rd-- d 4"' SE BOTTOM HOUSE TRIM COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp 0 Conditional Approval: Date low V,O even anri6ne Approved Date tI C 8149 Awl P Ron inspection Repori__ i- i- i 2.aoc Ao- -k PV7 e L I L E 71) T TH kA E RUE N 50 wr ELL (E),' 104.� APPROXI�. LOCATl041 '� I EXISTING DRAIN FIELD �10/ 5. 0 A 5. REMOVED 1250 SEPTIC 'TANK' LIE)—,' A PER MOA CODE Ti T2 IV/ CCRNERPAST tj 0 *�D(Q:O, INSTALLED 1250Q HDPE 223 - SEPTIC TANK W/ DCO AFTER J- 495 530 i 5 510 515 1 525 5+:} ''5 A B Ti 6.0 18.6 1 T2 13.9 j 17. DCO 1 - 17.6 ---- 15.87 'j C -SEPTI c�!D -AREA 21 Z F - o 0 0 0 z z 0 z Zul< < < z Dw w bi < U U 0 0 EL526.0 4 0 1250 g SEPTIC k TANK 527.2 PROFILE SCALE:NTS NOTES: PNE ENG WC, LLC RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 WOODRIDGE Bi L3 CAROL FRIES DRAWN j ACP 166411 VIRGO AVE. ANCHORAGE, AK ,` ""'" MUNICIPALITY OF ANCHORAGE en On-Site Water&Wastewater Program .No c' r:'''' PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 \ t http://www.muni.org/onsite \,,.�M epartment _� 4NOP AGE On-Site Wastewater Disposal System Permit Permit Number: OSP171225 Effective Date: 8/15/2017 Work Type: SepticTank Upgrade Expiration Date: 8/15/2018 Tax Code Number: 02009306000 Site Legal Address: WOODRIDGE BLK 1 LT 3 G:3337 Site Mailing Address: 16641 VIRGO AVE, Anchorage Owner: WEINER ARTHUR H & Lot Size in Sq Ft: 51188 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: If there are no existing double cleanouts downstream the tank, they shall be provided. Received By. 4 `_ , 1 Date: I, Issued By: 1 • 1 . a avt e5- 41 Date: 41/1r2C MUNICIPALITY OF ANCHORAGE Community Development Department Phone: -� \:`` Development Services Division ��— Fax 7- 7 +' On-Site Water & Wastewater Program Air,, ON-SITE SEWER/WELL PERMIT APPLICATION 122\ Parcel I.D. 020-093-06 Property owner(s) Arthur Weiner & Carol Fries Day phone Mailing address 16641 Virgo Ave. Anchorage, AK 99516 Site address 16641 Virgo Ave. Legal description (Sub'd., Block & Lot) Woodridge Block 1 Lot 3 Legal description (Township, Range & Section) Lot Size 51,188 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) (w/wo ADU) Septic Tank ❑X Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ 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. (Signature of property owner or authorized agent) Permit/Rush Fees: 1}k5-- Waiver Fees: Date of Payment: 1 1 110 Date of Payment: Receipt Number: 09961 I 6‘ G Receipt Number: Permit No. c(-39n 5 Waiver No. Permit App_ • '....c Pannone Engineering Services [lc Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com August 11, 2017 Subject: Woodridge Block 1 Lot 3 Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1,250g HDPE Septic Tank to replace an existing 1,250g Septic tank to be issued for this property. The existing tank has completely failed. It will be decommissioned per code. Currently the lot is developed. The proposed system will utilize a replacement 1,250g HDPE Septic tank that will be connected to the existing drain field. The existing tank is located approximately 100'+ from the well. The proposed tank will be placed outside the existing well radius. All required separation distances will be met. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5'+ from any property line or building foundation 10'+ from any water line 100'+ from any surface water 100'+ from any private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, .,,,.....I1, = s ♦♦♦11 • 11�.: Steven R.Pannone ♦ ;1%4. lC • , �� lsssssss 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 Development Services Department Building Safety Division ® On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 MarkBegich_ Anchorage, AK 99507 Mayor www.muni.org/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SW Parcel Identification Number:C?W •V$3 0� Date of Issue: _ Legal D��_ esgqcriptiion r - Property -.Owner Name & Address: � 1 1� Pump Installation Date: 2 Pump Intake Depth Below Top of Well Casing: %flt� feet Pump. Manufacturer's Name: Pump Model: �S/ 3�l ` _7 0 Pump Size / K hp Pitless Adapter Burial Depth: ! Z feet Pitless Adapter Manufacturer's Name: Pitiess Adapter Installer: Well Disinfected Upon Completion?: Yes ❑ No Method of Disinfection:�� //< L Comments: ! ! 7� ANCHORAGE WELL & PUMP SERV. Pump Installer Name: A=6 330 EAST 76TH AVENUE _ ANCHORAGE, AK 99518 PHONE: 907-243-0740 AWPS.COM �y UTA Attention: The pump installer shall provui —a pump installation log to the DSD within 30 days of pump installation. MUNICIPALITY OF ANCHORAGE — DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT — — -- NAME PHONE ®NEW XX§iX*4X X HIGHLAND DHSIGN, INC. ❑UPGRADE MAILINGADDRESS Star Route A Box T1 U/ - P, a Yo LEGAL DESCRIPTION- %� j I' L. o! 3 // /OCK LOCATION NO. OF BEDROOMS l�oh,/eh Vii 1 f lRob / Lre,-k AW 3 — Well Absorption area Dwelling PERMIT NO. O DI STANCE TO: teat /h / no/ ; h �2 U.I 7 Y I- Q Manufacturer p w� GrNer MaterialNo. of compartments m Liq. capacity in gallons Inside length Width Liquid depth IF HOMEMADE: _... -_ - p J VZ DISTANCE TO: Well Dwelling PERMIT NO. zManufacturer __ Material Liquid capacity in gallons m x wu.D DISTANCE TO: Well y/�/ h No. oflines: Length of each line,l Foundation n0/ ; 11 _ Total length lin�py Nearest lot line �� / Trench PERMIT (J Zee ,f% n 1 lY of with G tches Distance Distance between lines 1- / ¢ F O Top of tile to finish grade �r 2 GI'L(V(' � SOI— Material beneath tile /' q p �'O 2ry• inches — Total effective absorptioon area J_8 — 7 w Length Width Depth PERMIT NO. C7 ,Ia. F w u. Type of crib Crib diameter Crib depth Total effective absorption area pj DISTANCE TO: Well Building foundation Nearest lot line J J W � Class— DISTANCE TO: Depth Buildin foundation g Driller Sewer line Distance to lot line PERMIT NO. -- Septic tank Absor tmn areas) --®— p ®-- OTHER PIPE MATERIALS PVA GT — _ SOI L TEST RATI NG'' ��- INSTALLER S�A --- 'a ' - REMARKS / J ColrtYar, /7 r" 5/1GU/l C-ObCY" — — / -- S n eii" o� ro/1. p 211- ---- =A _ a, APPROVED — -----�� DATE LEGAL ----LO z7-tGl Loth li'lrcr �tfooclo� S`r( 12-073 (Rev. 3/78) DEPRRTMENT HEALTH AND ENVIRONMENTAL 9nTECTIOM 825 STREET, 8NCHORRGE, RK 99501 264-4720 ry: �'ii VA E> C, yj IHE �� U PERMIT NO, ( 820376 ) ��\/ APPLICANT HIGHLHND DESIGN INC SRA BOX 216I ]44~574] LOCATION VIRGO LEGAL L] 81 WOpDRIDGE LOT SIZE 44000 SQUARE FEE] TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/8R)= 205 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: f L. who ... ��T 5 — :1 EA CA vp FA %I no L. El EE F" -F 44 — E,:: 071 11K Hit 1. 1 :K ��- F- 1: pl; r - 1=1 lky un fis; X - J. GDEDCA ��0 EA 0.� PERMIT APPLICANT MRS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ----- 14,80 < AR :1 ��'T* I P -M 0.115 1= 9 Fl;�-: ff TY": ull Lj I IT FIE k7w BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT HILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL AMC- ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR R PRIVATE WELL OR 150 TO 200 FEET FROM 0 PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 38 DAYS. OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. I "El F&I 8 -1 1 -TEE 1-0 f" 31 Fit TYE 15 CNEECDEEPIEREVEFIT 73011., 1. 114 TEI 52! I CERTIFY TMHT 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR OM -SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOMS. SIGNED� A �rr�-��|1m/ Mib�!,|1�� n��ION INC [rL) 71f -->- ISSUED BY DRTE � 4/} -_�^ ____ ___�I,�� _8�� ,U SOILS LOG =� MUNICIPALITY OF ANCHORAGE • el DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST I. 825 L. Street, Anchorage, Alaska 99501 2044720 5'. C -- / SOILS LOG — PERCOLATION TEST PERFORMED FOR: JL/`/� At"M\S(_r:��/c/.� _DATE PERFORMED:_J'�-5 LEGAL DESCRIPTION:_ //.�!?Od t'"` 1 (1/'l 13 �� S OPL E SITE PLAN 1 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 18 19 20 COMMEN cio_(l L(1S Pr2S 4?_/ WAS GROUND WATER S ENCOUNTERED? yr,!�5 L 0 P IF YES, AT WHAT E — DEPrH? Iy Reading Date Gross Time Not Time i K Depth to Water Net Drop Pf Ito +�_- ro:�`io Y7:e� Lim 5' /l: 2o:e)o /0 .513 p8u r PERCOLATION RATE /'F (minutes/inch) C r/ TEST RUN BETWEEN l I' FT AND -2 FT PERFORMED BY: L�PIC/ rt/Ic¢. Frn.-(rM.„c, bJ<,or✓ CERTIFIED BY: DATE:�'J�L^'O� T 72008 (617 9) lqlolx 1,6364.11D. sorAlt 11"uprlia A ANul"011-A"np AiuimsiKA AA04502 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF.-, DRILLED AT THE RATE OF PER FQo-r. PROPERTY OWNER LOCATION OF WELL. SITE---- r,, n I DRILLER WELL LOG: ir"; I'a ne- ri I , ., . I , I, COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS 01 DATE— SERVICE. CHARGE 'F IV.% PER MONTH WILL BE AssEssr[3-- ON PASTQDLYeACCOUNTS. l 1'1 '1'' 11 r 1' 1) L L 1 IM(„ D �i) 0 1 `Dox 13000 STAR. ROUTjc A ANI uonAom, AxAmmA 00502 344n7714 SIX INCH WATER WELL DRILLED AND CASED OUT TO THE DEPTH OF . We. DRILLED AT THE RATE OF PER FOOT. PROPERTY OWNER LOCATION OF WELL SITE_ .3 -44L, DRILLER._1�FB�d�l1a l:_�; `.' .1 :)JIJ2J)'nr,4E.4- � —_— WELL LOG: V— w� < S��I ,17�i..L'{..�•1 ?....��r� ,�I.f1I641't:.o.__ __�� .^` _Y'� (ta/u�t .end r�u;:. .. `.c. �+�::•vr1 Scve^�� e„L.(.� 11a' iC'1:G` i ,;o wcivc: LCc:,- tZTL ,aw e�is !_{tn_L! 'K-•: .to V`7 Ir a. r . uxu C �r .i;C JWG±:,n (: ✓C_ qL- "3c to : 47 .:e.^.�`,.• 7 .i`,', ft,(.CL::.� .& ",..^.:... 254 f c '✓ ` 1 i a rx4a•U.!%.e. 7 7/^ c'y, P0 gxLtA4aeh hoar.. -2000 g4i4 24 hx t Lu: > k^ :e.. Cv✓ ee . a;'. r:r+ �.t ?r .{n a 72 h::,.A ✓s;:e 11=x. 1,6; "a'!, µ✓,:.,.a c L a cr c ; e dr_ ,.a- dnc', 3/; StLbr"-sPube : 4hCai+ be dri taUec 75 ,#e ag, Go;tor: sea!naeg ulownw ll"ovi Idea eBeaououV to J1!led!o!unW Ot 9 L b6,4 .3ni3D311 Go4t a,! 0 ,^.d :5”, 00' µwt loot. % 7010 4c;-, 657 0.650 COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF -'.57 2 Oc' THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE_ SERVICE CHARGE OF 1Vi% FIER MONTH WILL BE ASS126S& A FAST COC ONS. Mmucipality of Anchorage LIN! Maayyoor n. ncora9rorDepartment of Health and Human Services 825 "L" Street Rid(P.O. Box 196650 Anchorage, Alaska 99519-6650 October 6, 1995 Ted Moore, P.E. Flattop Technical Services 14530 Echo Street Anchorage, Alaska 99516 Subject: Waiver Request for Lot 3 Block 1 Woodridge Subdivision Waiver Request #WR950050, PID #020-093--06 1(1950 lig-� Dear Mr. Moore: Your request for a waiver of the required 10 foot separation between a septic system and a lot line has been approved. The waived distance is 9 feet from the south property line. This approval applies to the existing septic system lot line separation only. Any future upgrade to the septic system will .require all separations be met or another approval from this department. Sincerely, Robert W. Robinson On-site Services ljw #7 MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On-site Services Section Waiver Review Worksheet WR#jJ_L)-Z)()PID# 020--093-06 HA# N»`�, Permit: # Date Received: October 6, 1995 Legal Description: _Lot 3 Block 1 Woodridge Subdivision Engineer: _Ted Moore, P.E_, Flattop Technical Services _14530 Echo Street, Anchorage, Alaska 99516 ---_ Applicant: Stephen Rideout Waiver Requested: Lot line waiver of_9 feet from south property :Line Criteria: 1. Geology: Points: A. Water Table _ B. Soil Sorption C. Permeability D. Water Table Gradient E. Horizontal Separation TOTAh: 2. Special Conditions: 3. Other: ----- ---------- Waiver is Granted: Waiver is NOT Granteed: _— Lis Conditions or Reason/fs for. above: D E_ / Rec #: - N/A —— Amount: $ Date Paid: OLD S-Ve C'\ 0"'L' nu'Nl T A 'TOP TECHNICAL SERV" l:' e. CIVIL & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE E. MOORE, P.E. 14530 ECHO ST. PH: (907) 345.1355 ANCHORAGE, ALASKA 99516 October 6, 1995 e RECEIVED M.O.A. DHHS OCT 6199 P.O. Box 19-6650 Anchorage, AK 99519 Municipality of Anchora0e Dept. Health & Human Services Dear Sirs: By means of this letter we are requesting issuance of a formal separation distance waiver allowing the existing soil absorption bed on Lot 3, Block 1, Woodridge S/D to remain 9 feet from the south property line instead of the normally required 10 feet. Since this reduced separation distance was noted on the approved inspection report which was prepared in 1982, I understand that no waiver fee will be charged at this time. Issuance of the requested waiver will not have any impact on the ability to install wastewater disposal systems on Lot 2 which is located across the property line to the south for two reasons: (1) The subject system is a shallow bed, so the required separation distance between such systems is 10 feet, meaning that a non -conflicting bed could be installed directly across the property line within one foot of the property line, which is much closer than the requested waiver, and (2) There is a driveway on Lot 2 in this general area, rendering this specific area undesirable for construction of a wastewater disposal system. I trust that this information will enable you to issue a formal separation distance waiver; if not, please give me a call. Sincerely, OT cvc�i iru.•� Theodore F. Moore MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF: HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# (7_! -C`C;-�a--- HAA# 11-1,1 �LLIli-1 1.. 3. 4. GENERAL INFORMATION Complete legal description l ot3 ifs (tiaa�rrclge S� — Location (site address or directions) 16611 VIVO I- CAue Property owner S{eI2401 t Gc 01 R1deGuh — Day phone 2 1S- 19 1G� Mailing address165'40y` v o /i�rn�p� +Act A -r 9eS 16 Lending agency No/'A IgnoC/rum qe Day phone 271 -61.50 Mailing address 2605 Denorll, S u7FP too A- c4orr?74 Ai c 99-6`03 Agent 13ob 5,1tv,1D--tea=� Pone F1 o✓ Day phone 26/ -7611 Address 3111 C " S><. Su/Fe !Oa A-Achor p 9`?5-0-3 Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: TYPE OF WATER SUPPLY: 3 It 2�: O z 70 c� 6: n I'PI �� m D Individual well _ p y0 Community well _ Z5 z twit ca m n Public water "' a NOTE: If community well system, provide written confirmation from State ADEC atter m ing to the legality and status of system. 'TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site -- Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(A.v. 1/91) Font MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Flaki*4 %cAA;(gf Phone 326 -- Address yS3 U Ec Ao Sf. /}mac h a ray P A� 9es lG Engineer's signature . Date SP/' f 6. DHHS SIGNATURE Approved for Disapproved. ..Y:. id 7 �-y�•a�- ..Y:. id �-y�•a�- 7 bedrooms. Conditional approval for Additional Comments 0 aUTIC bedrooms, with the following stipulations: Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (flay. V91) Beck MOA X21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division oe*- 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: ko/ .3 1310CIr I W<>a r o! d Parcel I.D.: Well type p„ Log present (YIN) Total depth _ 2 Sanitary seal (Y/N) Date of test If A, B, or C, attach ADEC letter. ADEC water system number Date completed it/ Z _ 01 _ Cased to yG' Casing height (above ground) _2 H " FROM WELL LOG Static water level _ 1. Semi -ltle le Well production I• 9 g.p.In. WATER SAMPLE RESULTS: Wires properly protected (Y/N) Y AT INSPECTION m 13 / 9s- z 2 k/' 11"1 Fn y 7 CR"i Coliform 0 cot l (oc) tnt NitrateL�I-e Other bacteria g" , om rn ', Date of sample: 203/2.5 Collected by: _ r(a//oe Tec/1 $t'c X B. SEPTIC/HOLDING TANK DATA Date installed 1 u / t3 2 Tank size 125-0 9&/ Number of Compartments 2_ Cleanouts (YIN) r Foundation cleanout (Y/N) y Depression (Y/N) N High water alarm (Y/N) ni. 4 Date of Pumping 9 / 16 /9.9` Pumper _Ssa a c1 C. ABSORPTION FIELD DATA Date installed 1 U 27 / b Z Soil rating (g.p.d./ftz or It`/bdrm) Iso o'/Ly,,System type Oed _ Length 39 Width 20 Gravel thickness below pipe _6 '_ 2 y + Total depth H.5 Effective absorption area 7 0 o a) Monitoring Tube present(Y/N) Y Depression over field (YIN) N Date of adequacy test 9 t 13 / 9 r Results (Pass/Fail) Po.r c For bedrooms Fluid depth in absorption field before test (in.); 2 Immediately after 7Z3 gal. water added (in.): 3 Fluid depth 30 Minutes later: ? (in.) Absorption rate = y3-0 g.p.d. Peroxide treatment (past 12 months) (Y/N) Nuns Lnovrn If yes, give date z cc iP1 V <n OO NGn L O tO Date of sample: 203/2.5 Collected by: _ r(a//oe Tec/1 $t'c X B. SEPTIC/HOLDING TANK DATA Date installed 1 u / t3 2 Tank size 125-0 9&/ Number of Compartments 2_ Cleanouts (YIN) r Foundation cleanout (Y/N) y Depression (Y/N) N High water alarm (Y/N) ni. 4 Date of Pumping 9 / 16 /9.9` Pumper _Ssa a c1 C. ABSORPTION FIELD DATA Date installed 1 U 27 / b Z Soil rating (g.p.d./ftz or It`/bdrm) Iso o'/Ly,,System type Oed _ Length 39 Width 20 Gravel thickness below pipe _6 '_ 2 y + Total depth H.5 Effective absorption area 7 0 o a) Monitoring Tube present(Y/N) Y Depression over field (YIN) N Date of adequacy test 9 t 13 / 9 r Results (Pass/Fail) Po.r c For bedrooms Fluid depth in absorption field before test (in.); 2 Immediately after 7Z3 gal. water added (in.): 3 Fluid depth 30 Minutes later: ? (in.) Absorption rate = y3-0 g.p.d. Peroxide treatment (past 12 months) (Y/N) Nuns Lnovrn If yes, give date D. LIFT STATION Date installed Manhole/Access (YIN) High hater alarm level at* Cycles tested E. SEPARATION DISTANCES Size in gallons "Pump Oil" level at* *Datum SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot /to I "Pump off' level at* On adjacent lots > 1001 Absorption field on lot 138' io m • t IOn adjacent lots Public sewer main Sewer /septic service line Public sewer manhole/cleanout N. A, Lift station SEPARA'T'ION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 67' Properly line 4:rlS Absorption field 16, Water main/service line > 2 s'' Surface water/drainage > too' Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation - 26' Water maimiservice line > 2s, Surface water = 130' Driveway, parking/vehicle storage area ^ 10' Curtain drain None seems Wells on adjacent lots > too' F. ENGINEER'S CERTIFICATION fP M•c( 13' froml7� Per cr4 -6/f shrrc� h ur tot .e rey held 9' n• jJ!r per 6a4pro VFW inti. Repan l I certify that u field inspections and review, ofiVio icipal records theW the above systems are• in conformance with A40A HAA guidelines ineffect on this date. 0,gear lv be Signature •/, J 9)1 �t Engineer's Name Theodore /_. %10or� Dale HAA Fee $ 3G0 Date of Payment � p / Receipt Number /�/0 Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number J"aSif lOQ 1p s P ,up .�.�n rX. �n Daae. ....'s ........... e:•e Ti1EODME r, ;,1002E rcr 1 1 NL INFORMATION'" . Lot 3: !Md -� `,.w6bdUdae Subdi.v.is oA 16641 V' Lo Avenue' Anchonaae;. AK _� 9,9.508 77 1, *jjom s, oauibue luuolsseloid aqj ui suoissiwo jo sjojjE) jol opsuddse? IOU sl' ebujoqouV to AilludiownV4 eq.1. 'ponssi sl, ejumppoo L, ejolaq g1up GzApua jo suoiloodsui jonpucio IOU OPSHHG josGaAoldwB'SluewejllibaialuisOua ILIJ6091 ujal eo/qsl ILsoliepioutsuoilnilisulouipubi)loqlpue sowoqlosjoseqojndolAsepnooLsgslqisBOPSHHCIGPI�LINSUIV 1 10 (PIS 9141 U1 pajolsiBei i9quibuo laumsajoid juapuedepui ue Aq 9Adqu g tAdwBeied Ul UGA16 suoijujuesaidej atp uodn Aluo poseq selvoilpeC) 1BAoiddV Al!joqlnV 4j1e0H sonssi (SHH(l) 13001AJ9S u'3LUnH PUB WIUGH jo juowjjLd9C] abLjoqouV to AlpidiownN eq_L 4 tJ4&Cl +-LjwTA —lqM :Ag" sjUqwwOo'l8UOljlpV molIvIndils Buimollol oLp qjlm Iswoojpeq JOI 11RAoidde leuoilipU60, p9AbjddvsiC3' -swoojpoq 10 PBAOJddV: u4uu einivuBis s,�jqeui6u3:L' �Xwo -VN ~!d wimud MWL ssqjppv Lb 2, 9UOqd LUJ!J 10 GLUUN -uopedsui siql to ejup eqj uo loop ul suoijuln6ei pue 1sqOUvUlpjO 'sopoo ejejS puu ludioiunVq lie qjlm oomildwoo ui sl welsAs jusodsip jejumg1sum jo /pus Alddns jolem ells-uo 941'uopo9dsui PU10 UOIJU61499AUi Aw wojl pue sell; ebojoqouV jo'f4lledioiunvq eqj LuoilpeuiulqouoileLujojuieqluoposLqluqli4!JOAAOOIJ.niI -uiejeqpeluo!puiainionjislood�4puL, swoojpaq jo joqwnu eqj jol ejunbape puv lvuo!jou6j apas sl walsAs jusodsip jejumelsem jo/p Ou AldcIns jolem ells-uo eqj jvqj smoqs,uoijuollddu. l9AojddV Al!joqinV 411801-1 sly; ;o U0!;L161jS9AU1 Aw jvqjAj!J9A I'molaq UMOq9Gj1RP U0jj'apjlUA0qjj0`se PUL"Olejeq Pexplu pesAw Acl poi 4090 sv' rp U33NION3 AS: NOLLOUSNt"A0 INMiLVIS Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL. CHECKLIST Legal Description: Lor 3 /SLK I WQQP21OC�- Parcel I.D. A. Well Data Well type FLQIVA T�- If A, B, or C, attach ADEC letter. ADEC water system number_ i Log present YEN)��Date completed 1 1SOI FZ Driller �64p yyK(CL/N& CJo.4CS Total depth Z G0' Cased to 4o '-J-- _ Casing height Sanitary seal(�N) S _Wires properly protectedcyiM FROM WELL LOG Date of test 1136 8Z__ Static water level 04�O STf3nJDl N(, Well flow Lr � g•p•m- Pump levell _ vK SEPARATION DISTANCES FROM WELL TO: AT INSPECTION O `1 9-- 3 o z � c>, 4 Y. g.p.m.m gj m O m n '^ m Septic/holding tank on lot ; On adjacent lots % z Absorption field on lot _ � ; On adjacent lots _ / Public sewer main —ZS /F _Public sewer manhole/cleanout Ov /d Sewer service line as (f- Petroleum tankMsAJC K/Jc c.,r-i WATER SAMPLE RESULTS: Coliform c>�/^� Nitrate_Other bacteria Date of sample:_ -f 9 �� Collected by: �rJro /N�c�ytr /J B. SEPTIC/F ANK DATA Date installed (2 Z __Tank size X250 GSL_Compartments_ Z Cleanouts &N) 1 C S _Foundation cleanout( N) yfv� _Depression (Y6 NC, High water alarm (Y& ✓'' __ Alarm tested (Y/N)_ Date of pumping _ U 2Ig Pumper SEPARATION DISTANCES FROM SEPTIC/} -TANK TO: I Well(s) on lot JOO I -- _On adjacent lots /60 Foundation To property line _/O r4- Absorption field S (r/- _Water main/service line /0 Surface water/drainage 72•02e (3193)• Front CONTINUED ON BACK PAGE C. LIFT STATION 0 il N C� /Pk 6t -fc-i l Date installed Manufacturer Size in gallons M Vent(Y/N) High water alarm level Meets MOA electrical codes "Pump on" level at SEPARATION D1sTANCE FROM LIFT STATION TO: D. ABSORPTION FIELD DATA (Y/N) "Pump off" Level at Cycles tested On adjacent lots Surface water Date installed /o/ 2 2 L 9Z Soil rating (GPD/Ft2)500 1sez System type Length 1� / r Width 20 ` Gravel thickness 2 4 I Total depth 4 Total absorption area "Cleanout present �/�) ��S Depression uover field d((Y N)) Iva Date of adequacy test z Resultas ail) 0' fS for II12LG Bedrooms Water level in absorption field before test d Aftertest (0"A r ? jZ NCS Peroxide treatment (past 12 months) (Y/N) /0 or ---)6 )oujN If yes, give date �J SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot / ccs (f On adjacent lots zc�) c-.> 'f Property line To building foundation �U f To existing or abandoned system on lot M Nc 6'ZtJ On adjacent lots Zo /+ Cutbank MntJE P2CJEXI— Water main/service line /0 / J-- Surface water ZO �) / 7 4- Driveway, parking/vehicle storage area Or Curtain drain , Jdfje r/kl U WN E. ENGINEER'S CERTIFICATION I certify that I have checked, verifie con rmed to all MOA and HAA guidelines in effect on the date o/ this inspection. Signature4 lej 5N NEERING Engineers Na e Date eagle River, Alaska 99577 3 Z,q ItC HAA Fee $ 3 co `U D Waiver Fee $ Date of Payment 13- a 4- 9�h Date of Payment Receipt Number c� �T 7 L / 1 ��'✓li%/ Receipt Number, 72-026 (3/93)' Back • MUNICIPALITY OFANCHORAGE fiA DEPARTMENT OF HEALTH & HUMAN SERVICES M Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # _ Qa_0__ 1Ci � _ C i n _ HAA It 0 Qq \ n1 q \ 1. GENERAL INFORMATION Complete legal description Lot 3; BKock 1: Woodridge Subdivi6.ion; Location (site address or directions) 16641 V.ingo Avenue Property owner WxitUam & Sus. Genace Day phone Mailing address 16641 V.ucgo Avenue Anehwcage, Ataska 99516 Lending agency Mailing address. Agent Address — Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water — Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Fr.M MOA #21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm 5 & 5 ENGINEERING Phone Address 17034 Eagle River Loop Road No. 204 Engineer's signature 6. DHHS SIGNATURE ,.� Approved for ✓? bedrooms. Disapproved. Conditional approval for Additional Comments 0 Date bedrooms, with the following stipulations: Date Z& L� The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 1/91) Back MOA 021 e Municipality of Anchorage Department of Health & Human Services FH HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ��R o o `�o Parcel I.D. 19 A. WELL DATA Well type v u1 r If A, B, or C, attach ADEC letter. ADEC water system number -� Log present (9/N) _�� Date completed -'a7 Driller Rte PL,�r 1>� 1��. CO Total depth —Cased to- etc } Casing height \2 - Sanitary seal CG j) _ Wires properly protected ON) _ FROM WELL LOG AT INSPECTION Date of test `3"`\ 1 Static water level U 2`t Well flow 1 �� _g.p.m. - 4A '(D g.p.m. Pump level Z.Sb' SEPARATION DISTANCES FROM WELL TO Septic/holding tank on lot 1r_X:>.k ; On adjacent lots Absorption field on lot _ � moo' _ ; On adjacent lots moo' Public sewer main '_Abs, _ Public sewer manhole/cleanout Public sewer service line -�L' Petroleum tank ', Al WATER SAMPLE RESULTS: e-�v r1(a Coliform ��_ - Nitrate — � u Other bacteria Date of sample: -6 -`tt Collected by: -- S & S ENGINEERING B. SEPTIC/HOLDING TANK DATA 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Date installed Tank sizes Compartments Z- Cleanoutsd57N) Foundation cleanoutdYN) --4Depression (YMP r High water alarm (Y/QI r. -A Alarm tested Date of pumping LL -.P- S P )r�PirAL,1 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well (s)onlot IaC�,lt- -On adjacent lots 11�o`d __Foundation ti 1� To property line- �'' Absorption field �`� Water main/service line_ 1+ Surface water/drainage ' 7&026 (Rev. 3/91)Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION .' Date installed Size .iq gallons a`�nI (YLR411�(( Pt High atep<aavXlevel Meets MKI electrical codes (Y Manufacturer Manhole/Acte level at "Pump off" level at Cycles tested SEPARATI=DISTAFROMLIFT STATION TO: Well on lotOn adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed tC>-Z I — gz Soil rating t SDR System type �ED Length Width Zot Gravel thickness Z t Total depth Total absorption area 723 0 Cleanouts present(aSCaN) NJ Depression over field (Y61� r, Date of adequacy test Results as ail) for —T r1bedrooms Peroxide treatment (past 12 months) (YO o If yes, give date 1 SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot oo t } On adjacent lots t Oo"— Property line q To building foundation tpt+ To existing or abandoned system on lot Aj/- On adjacent lots 3d} Cutbank �� } Water mai n/serviceIIRe \t } Surface water Driveway, parking/vehicle storage area Curtain drain )A E. ENGINEER'S CERTIFICATION 1 certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S tk 5 cfvlihd�Wi31'IfdG - '3�°F�. Signature 1%D? , a_)Ic t iVPP f.001J t2BBtl NO, 2D4 rF,, Eagle Ftivm•, A h6k a VVIV/ Engineer's Name' Date , , X✓ HAA Fee $ 70,Waiver Fee: $ Date of Payment %— Date of Payment Receipt Number L� // \ 0 Receipt Number 72-026 (Rev. 3/91) Rack MOA 21 II I I I- r,,.. ` ` .. Time --- Time ---- APPLIC; JT FILLS OUT UPPER MAL.WILY Prepz,ly-Owner L /%% r .i . �.-:• Date -- Date ---- Date Mailing Address �- - Zip Code Buyer Field Notes: !_1r U etll- ^^- J f < �'JR <� S'�GUVv L K ,., f�C1 ICIEPT. HEALT6HURA6� OS,�Auno ri/2.-P„� DEPT. OF HEALTH l: 11 - a, 1Jpo-Z77 -..- Address " ;'� n% i`;,�;� �. '� Zip Code Lending Institution ��/,. -'� .;x --/r, -- / ;�� Phone Address �� %rz i �) _� �,�. ; ^n% Zip Code ��: Realty Co. & Agent 7/..6 Phone ( ) DISAPPROVED ( ) CO/N�DIl1OVL A VAL* Address ZipCode Legal Description Street Location MA Type of Residence Area t--!^^ Well Log Received /VC F�.• [J Single Family ❑ Multiple Family No. of Bedrooms - _- ❑ Other WaterSupply \ 0-dividual ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Community -� � For wells drilled prior to that date, give well depth (attach log if available). El Public Utllily Sewer Disposal ❑-rdividual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: ❑ Holding 'rank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time --- Time ---- Time Time Date Date -- Date ---- Date Inspector Inspector Inspector Inspector p — `F Field Notes: !_1r U etll- ^^- J f < �'JR <� S'�GUVv L K ,., f�C1 ICIEPT. HEALT6HURA6� OS,�Auno ri/2.-P„� DEPT. OF HEALTH l: 11 - a, 1Jpo-Z77 -..- -------��— --'-�_---_-- - ENVI�I ONMENTAL PROTECTION pm m -t 1', - ��: (3 ) APPROVED BEDROOMS CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CO/N�DIl1OVL A VAL* DATE BY: MA Soils Rating Date Sewer Installed WlTo Absorption Area t--!^^ Well Log Received /VC F�.• 10 �-j 7 -� 7_ twe111 to Tank F2 023 Pro Juno 17, 1903 Highland Design, The. Jin AralsUanq SRA iox. 3163 Anchorage, AK 99507 Subject: Lot. 3, block 1, flood Ridge Approval for the individual. sewer and water I'nci.l r cion cannot he granted until the following items have been coraial_t, i.ed t A tial] lay_ :;a.ahm:i.tted to this of lice Eon our files and review. The top of the well casing ng should be scaled so that it i:,a water Light. The Ciopresn:i_on or: pit around the well casing needs to he ,11 filled with impervious type soil so that: it slopes away trom the well casing. ° Esposied electrical virus to the well head arein violation Ur_.. the Municipality of Anchorage codes and must he encased in conduit, 1 ° _Ihc c-jater analysis report needs to he submitted to this office from the Chem Lab, b633 it Street, for our review. Who depression over the sower system ca viIL need to be killed 64 o that surface v:atur drains away meat the ever y: tewr Please notify %hi u Uup arLmont for a re:iaas'puct:i.on when the noted discrepancies have been corrected. IF there are any further questions, please Call this utficu at 264 -172U - Sincerely, Cory Ai.11.is CAG/ea/t,7