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HomeMy WebLinkAboutCLEARVIEW LT 1Clearview
Lot 1
#015-242-40
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number: 0 i5. 2-qZ •UQ
Legal Description Property wner Name & Address:
new J'If
/+
0? aY t/i � I C �lS/So
Pump Installation Date: �
Pump Intake Depth Below Top of Well Casing: feet
Pump Manufacturer's Name:
Pump Model: �
�%/M I
Pump Size % / hp
Pitless Adapter Burial Depth: /d feet
Pitles'$ Adapter Manufacturer's Name:
Pitless Adapter Installer:
1A11 Disinfected Upon Completion? Yes ❑ No
X. -hod of Disinfection: / f � 0
194
Comments:
ANC"0RAGE VAM & Rlhi SERV.
Pump Installer Name:J* 330 EAST767"AVENUE
ANCHORAGE AC 99518
PNORIL 907-2430740
AVA5AXM
Attention: The pump installer shall provide a pump installation log to the,DSDwithin 30 days of pump installation.
Development Services Department
Building Safety Division
8u
On -Site Water &Wastewater Program
4700 Elmore Road
P.O. Box 196650
Mark Begich
Anchorage, AK 99507
Mayor
www.muni.ora7onsite
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SW Date of Issue:
Parcel Identification Number: 0 i5. 2-qZ •UQ
Legal Description Property wner Name & Address:
new J'If
/+
0? aY t/i � I C �lS/So
Pump Installation Date: �
Pump Intake Depth Below Top of Well Casing: feet
Pump Manufacturer's Name:
Pump Model: �
�%/M I
Pump Size % / hp
Pitless Adapter Burial Depth: /d feet
Pitles'$ Adapter Manufacturer's Name:
Pitless Adapter Installer:
1A11 Disinfected Upon Completion? Yes ❑ No
X. -hod of Disinfection: / f � 0
194
Comments:
ANC"0RAGE VAM & Rlhi SERV.
Pump Installer Name:J* 330 EAST767"AVENUE
ANCHORAGE AC 99518
PNORIL 907-2430740
AVA5AXM
Attention: The pump installer shall provide a pump installation log to the,DSDwithin 30 days of pump installation.
Municipality of Anchorage
• Development Services Department e
.,_
Building Safety Division
_
On-Site Water 8 Wastewater
Program, 4700 South Bragaw St.'
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us (907) 343-7904
Paye 1 of 3
On-Site Wastewater Disposal System and/or Well Inspection Report
Permit Number. SW040422 PID Number. 015-242-40
Nome:
DALE TROMBLEY Wastewater System: ❑ New ■ Upgrade
Address:
7850 ALATNA AVENUE is ANCHORAGE, AK. 99516
ABSORPTION FIELD
Phone: No. of Bedrooms:
(907) 345-0723 5
O Deep Trench ■ Shollow Trench Dead O Mound O ether
LEGAL DESCRIPTION
s" Rete
1.2
Tctci a"'" Non''neh'a lied"
81ock: Lot: Subdivision:
— 1 CLEARVIEW
GPO/sa
D.Pth to pipe potion. Nan, myna snedo:
FL 9.0 MAX n
Gww d.pth b.nroU ypr
SEE DWG.
rL 4.0+ rt
Township: — Range: — section: —
A edited a,ow "trial "ed
Greva wyth:
SEE DWG.
n 64 (2032) rL
WELL: ❑ New ❑ Upgrade
Grew .:ah:
5
Nan{w of en..: aortia. banned bed:
2 15
ClopiNp.ti.r,Prlpt., Ae.C): Tool Gnaw To:10MR00T
TOW ob.orption erne:
rt n
rr,.l.n
Npi, a:
`r(`, rt R
640+ sG.
n D 3034/ F-810
ate' \\A- to pWd: stoop waw 1~.
FL
10,aoyn aa. Mand:
GEG. Ltd. 11/3-5/2004
nod:
cc" N.yhl Above crowd:
G� rt
rL
TANK
SEPARATION
DISTANCES
■septic 0Holding 0S.T.E.P. ODther
To
From
Septic
Tank
Absorption
vele
Lift
station
Holding
Tank
/Pn.at.
sr w Dn.s
wo.Aoclww:
ANCHORAGE TANK
GepooiV in apron.: 0ee♦
15001660"'"'
Well
too'+
100'+
—
—
25'+
STEED
a p
2
Surface water
100'+
too'+
—
—
—
LIFT STATION
Lot Une
5'+
t0'+
—
_
_
s" In "Maroc
wo,ufectww:
Foundation
5'+
m k.a a: pat a:
Nqh doted warm a:
Curtain DrainNONE
KNOWN
o.pNka knpwlipn. °'nano'° br
Remarks:
BENCH MARK
THE OLD SEPTIC TANK WAS ABANDONED PER UPC.
_
TOP OF LOWER DECK AT POST
Avunwd f).wkan;
00.00
rt
ENGINEER'S S
F
o F,� • • .•q��U
v S COQ
Inspections performed by: GEG, Ltd. Dates: 1st 11/3/2004
-.
2nd 11/4/2004
„•, ..........
D
3rd 11/5/2005
Q
Je f e A...... ss.
Development Services Department ApprovalQ
00 Q°o •, C 795 �O
Reviewed and approved by: Date: fQT��/
Q04 profe�Slpnic�
(R«.12/07 I -
�40000��
PERMIT NUMBER:
AS -BUILT D RAS Z I N G PARCEL ID NUMBER:
SW040422 015-242-40
I I
I I
I I
100' WELL RADIUS
IG BED ABANDONED /
10E FOR POSSIBLE
FUTURE USE. /
DRAINFIELDS / \
S _ /
THl1 iDBL1 A,_RETAINING WALL
LLJ
ry
V)
E3
10IIIIIIIII�:
ST1
51.03
41.68
ST2
47.33
50.03
DBL1
45.92
54.03
DBL2
46.29
55.26
FS
61.44
68.86
C01
61.36
97.10
MT1
63.53
66.33
CO2
67.38
42.95
MT2
68.83
46.92
CO3
73.72
72.61
MT3
76.11
74.34
C04
81.85
54.57
C04
83.47
56.90
WELL ABANDONED
BY ARROW PUMP
\AND WELL SERVICE
\11/15/2004
1
INACTIVE WKELL
10' UTILITY EASEMENT
— _ _ _ _.�..
DATE:
11/18/2004o�F t,4
b� DRAWN BY: o�� S�0
GARNESS ENGINEERING GROUP, Ltd. R.A.L. ppm O
SCALE: �. �0
CONSULTANTS d GENERAL CONTRACTORS. O
3701 F. TUDOR ROAD. SUITF 101 • ANCNDRAGF. AK 00507 • P ONF (407)33)-AA4 • FAX (407)338.3746 1 - 40 • • • • • •' .......
""
PREPARED FOR: PHONE NUMBER: PAGE NUMBER: 0
DALE TROMBLEY (907) 345-0723 2 OF 3 ,j Gor ess.
oa��0
LEGAL DESCRIPTION: _
CLEARVIEW SUBDIVISION; LOT 1, �i/za/4�FoopO
TYPE OF WORK:
AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE4oQ4pOpp0O0�
PERMIT
SW0NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER:
SW040422 015-242-40
FINAL GRADE
104.02 (AVG.)
TOP OF TANK AT
INLET - 97.71
INVERT OF BUNG
AT INLET - 97.12
LOWER TRENCH
FINAL GRADE
99.31(AVG.)
RELTTNE ELAVATION OF
OF TEST HOLE O 83.7
n
L4
NEW 1500 GALLON
DEEP BURIAL
SEPTIC TANK'I
FINAL GRADE UPPER TRENCH
OR- 98. DE GRA102.25(AVC.
98.76 O I I I I
HIGHEST POINT
INVERT OF PIPE
93.79 (AVG.)
BOTTOM OF TRENCH
89.76 (AVG.)
10'
.,r
11/18/20
.....___._....... .. _.__. ...
DRAWN BY:
GARNESS ENGINEERING GROUP, Ltd. R.A.L.
�� CONSULTANTS& GENERAL CONTRACTORS SCALE:
3701 E TUDOR ROAD, SUITE 101 • ANCHORAGE. AK 00507 , P ONF (007)337-600 • PAX (007USPJl46 1 w C 409
PREPARED FOR: PHONE NUMBER: PAGE NUMBER:
DALE TROMBLEY (907) 345-0723 3 OF 3
LEGAL DESCRIPTION:
CLEARVIEW SUBDIVISION; LOT 1,
TYPE OF WORK:
AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE
TOP OF TANK AT
OUTLET - 97.69
INVERT OF BUNG AT
OUTLET - 96.90
[&all
INVERT OF PIPE
96.00 (AVG.)
)TTOM OF TRENCH
91.98 (AVG.)
AAR1
1
n111 �U�1� & �VEII SFR.1%ICE, LLC �}
Ro. eox 1.10996--
Lnr!;rra0e. AK 99511
C"icc 1')0713,16-1355 • Fax (Q971 333-FO'6 7l
a:m..r: (907) 795.9077 • EaDIe River: (907) 622-9335 1
CUSTOMER JOB SITE
r
t I
Ada..------....__.._.
--- - ------ - --
I• -?!+L YOU
SIGNATURE
d u�•,.... A-inn:•Irr!�� •!.. C,+,'•�'�.•n..; i•.�^•� Ir''�+, n• Ihr. A!.C'/r Dn,Sfnprq v/..ry 1
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.S% PER MONTH WILL BE CHARGED ON OVERDUB ACCOUNTS.
rare•
;vrt
f•gOnigntED
rVA•r pF rrH
SALESrEnc(Al
- ;PJANTITY DESCRIPTION
jji�QµUd N � 'T& GY .
PRICE
AMOUNT
tic�rT� eG sT
--e-r-
hJ;ll;c
--
I
r%ov1 i
. Jle ----- -
-- ---
----
--
c^Q HOURS
RATE
AMOUNT
TOTAL MATERIAL
TOTAL LABOR
i
- -o.+roc0 2yj DATE COMP.
TOTAL
LABOR
PAY THIS AMOUNT
I
I• -?!+L YOU
SIGNATURE
d u�•,.... A-inn:•Irr!�� •!.. C,+,'•�'�.•n..; i•.�^•� Ir''�+, n• Ihr. A!.C'/r Dn,Sfnprq v/..ry 1
TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE.
SERVICE CHARGE AT RATE OF 1.S% PER MONTH WILL BE CHARGED ON OVERDUB ACCOUNTS.
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Initial / Upgrade
Permit Number: SW040422
Legal Description: CLEARVIEW LT 1
Design Engineer: 0855 Gamess Engineering Group, LTD
Owner Name: DALE TROMBLEY
Owner Address: 7850 ALATNA
ANCHORAGE. AK 99516-2538
Date Issued: Oct 08, 2004
Expiration Date: Oct 08, 2005
Parcel ID: 015-242-40
Site Address: 007850 ALATNA AVE
Lot Size: 53709 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit Is for the construction of:
❑,/ Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 ( IBAAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling
(907) 343-7904 ( 24 hours). ( Not required for a Water Supply Permit only).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
Received By:
Date:
Issued By. I I /I" Date:
Municipality of Anchorage
Development Services Department
— / Building Safety Division
On -Site Water 8 Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. C�I�"�- QgC2 -u> Permit Number
Property owner(s) DALE TROMBLEY Day phone 345-0723
Mailing address (1) 7850 ALATNA AVENUE • ANCHORAGE. AK.
Mailing address (2)
Legal description (Lot, Block & Sub'd.) __ LOT 1: Cl ARVIEW SUBDIVISION
.. -
Legal description (Section, Township & Range) N/A
Lot Size Acres q.Ft. Number of Bedrooms 5
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
❑
Sewer and Well
❑
Water Storage
❑
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal codes.
GARNESS ENGINEERING GROUP Ltd.
Permit Fees:
Date of Payment: /(kl_ Log
Waiver Fees -
Date of Payment:
Receipt Number. Receipt Number.
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
October 1, 2004
Municipality of Anchorage
Development Service Department
Building Safety Division
On -Site Water & Wastewater Program
P.O. Box 196650
Anchorage, Alaska 99519-6650
Ref: Proposed Septic System for Clearview Subdivision, Lot 1,
To whom it may concern:
The existing 5 bedroom house is served by a private well and septic system. There are three
wells on the lot, two of which are inactive. The inactive well to the north is encroaching on the
existing and proposed septic tanks, and will be abandoned during construction. The drainfiled is
in the state of failure and needs to be upgraded. One test hole was excavated on the property.
The drainfield will be designed around the 30 foot radius of this test hole. We excavated and
confirmed the existing septic tank is of poor integrity. We are proposing that a new 1500 gallon
septic tank and a dual trench type drainfield be installed. Comments regarding the design are
summarized as follows:
1. SOILS: See the attached log which shows the soil classifications, groundwater monitoring,
and the percolation test results.
2. TRENCH DESIGN:
a. Percolation Rate: <1 minutes/inch
b. Proposed Application Rate: 1.2 gallons/day/112
c. Number of Bedrooms: 75
d. Design Flow: 750 gallons per day
e. Minimum Absorption Area: 625 R2
f. Total Depth: 9 feet (max.)
g. Effective Depth: 5 feet
It. Width: 2.5 feet
i. Minimum Length: 64 feet long total (2 @ 32 feet long each)
j. Effective absorption area = 640 R2
3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507
Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: gamessengincering.com
3. SURFACE WATERS: There are no surface waters within 100+ feet of the proposed septic
system.
4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average
topography in the area of the proposed drainfield is approximately 5-10% running east to west.
In short, there are no slope concerns.
I am unaware of any adverse impacts this installation would have on adjacent wells or septic
systems. If youave any questions, please contact us at 337-6179. Thank you for your
assistance.
P.E., M.S.
NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils log,
and a 7 page construction specification letter which are all part of the design package for this
septic system.
3701 E. Tudor Road, Suite 101 " Anchorage, AK 99507
Ph: (907) 337-6179 • Fax: (907) 338-3246 • Website: gamessengineering.com
LOT 22;
CLEARVIEW S/D
1
1
1
/ LOT 23;
/ CLEARVIEW S/0
CIFARVIEW LOT 24; /
\ 5/D
LOT 1;
MEAR S/D
LOT 2;
MEAR S/D
EXISTING
MC SYSTEM
LOT 10;
CLEARVIEW S/D
n
% XN
—24-� \ LOT 3;
1
I
/ LOT 2;
CLEARVIEW S/D
•�RETAINC WALL \\
CLEARVIEW S/D
♦WELL TO BE ABANDONED
D ING CONSTRUCTION
EXISTING \ ; %
S BEDROOM% 1 /
HOUSE
\\ EXWNG
\ WELL /
LOT 1;
PRESCOTT S/D
1
i
I
I
I
I
- --- - R A.L.
GARNESS ENGINEERING GROUP, Ltd. '` Y
-'
CONSULTANTS& GENERAL CONTRACTORS SCALE: LS Q
3701 F TUnC 00AD. SUITF iM • ANC�.MAf F. AS 00501 • cl•0Nc (001II51-0DO • cez (00113•n.l)/.� 1 100'ii
PREPARED FOR PHONE NUMBER: PACE NUMBER: $;
DALE TROMBLEY 345-0723 1 OF 2
LEGAL DESCRIPTK)N: •+1+•9.'
CLEARVIEW SUBDIVISION; LOT 1. V•,+
TYPE OF WORK: 1+��
SITE PLAN FOR PROPOSED SEPTIC SYSTEM UPGRADE
LOT 4;
CLEARNEW S/D
D
INSTALL \ /
MI ILII r
EXISTING SEPTIC
SYSTEM TO BE
COMPLETELY ABANDONED /
W I
I
I
TWO TRENCHES THAT ARE 9 FEET
DEEP MAX. BY 2.5 FEET WIDE. BY 32
FEET LONG EACH (64 FEET LONG
/
TOTAL). ADD S FEET OF CLEAN
WASHED SEWER DRAINROCK.
i
14
„-iRETAING WALL \
�7'✓✓ I �WELL TO BE ABANDONED `•
/ \DURING CONSTRUCTION
PROPOSED 1500
GALLON SEPTIC •:
TANK \
I. f
i
.` NG EXISTI_ - - / /I
•' ---- _ INACTNE WELL
— — — — — — to' Tm:m EASEMENT — NOTE: THE CONTRACTOR
SHALL HAVE ALL WELL RADII
SHOWN FLAGGED BY 4
REGISTERED SURVEYOR PRIG
Try /HSAIQTDI I/•TIlSAI
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS & GENERAL CONTRACTORS
5701 F TIAOR ROAD, SUITF 101 • ANCHO AGF. AK 00507 • P,I( (007)557-0170 • FA[ (001)318J7L6
PREPARED FOR: PHONE NUMBER:
DALE TROMBLEY 345-0723
LEGAL DESCRIPTION:
CLEARVIEW SUBDIVISION; LOT 1,
TYPE OF WORK:
DESIGN FOR PROPOSED SEPTIC SYSTEM UPGRADE
10/01/2004 0�
tAWN BY:
R.A.L.' 1
1" = 40'
NUMBER:
2 OF 2
MKINA"m
N,-3r4ess:•
.._ _..--------------�-��-~'- �� � _ _ � ` _ ____ __ __. __.. _, o'�F.:•�F' •:9500
GARNESS ENGINEERING GROUP, Ltd.
CONSULTANTS d GENERAL CONTRACTORS
0......... .... ..........0
ML 11100. RYD. RIIfE 101 • /�MClg0..0� N0 Po!0) • RIg4: 00I l-•179 • !u: Po! 33M • 1YlD5fiC p..�.p,rp,•w
SOIL LOG — PERCOLATION TEST D
LEGAL DESCRIPTION: CLEAFMEW SUBDMSION; LOT 1• 0 of a A. ess.- a
PERFORMED FOR: DALE TROMBLEY DATE: 9/22/2004 Q��� —7953 \F4O
DEPTH_ s 'Io(1'0100
(reef) ___= TEST HOLE 1 A���4000��00.�
1 ORGANICS
2 SOIL CLASSIFICATIONS
GW ORG,
. !•:. .,
3—.
GP IML
.•. GM CL
�••`'�`GC OLSW MH
/
5 �.•.` ..•.•. SP CH •�'l SM OH
SP/GP
•••' TH#I+
or SC
7 ••"
::g, DATE
r.
6 ,.
.. �•
•. ••.
•:••••: SITE PLAN
••�
•� ;• � +f ---------------------- 1•=100• -
10 • •••
.:; :• SP
11 •••••
.. • .::•
.....•.
13
14 GM/ML
15
16
17
18
19 PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES)
TEST RUN BETWEEN 4.0 FT. AND 5.0 FT.
20 A FOUR HOUR PRESOAK WAS PERFORMED: ❑ YES N NO
SOILS LOGGED BY: SUSAN OSWALT PERCOLATION TEST PERFORMED BY: ROB CAMPBELL
COMMENTS:
PERFORMED BY GEG• Ltd. I, JEFFREY A. GARNESS. CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: 9/29/2004
DEPTH TO
GROUNDWATER
READING
DRY
9/22/2004
DRY
9/29/2004
DATE
READING
CLOCK NET TIME WATER LEVEL
TIME (MINUTES) READING
NET DROP
(INCHES)
9 23/2004
.NPN
PgSO Np\
1
iz-u i3 tnev. 3/ /8)
—� MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL
PROTFCTION
I ENVIRONMENTAL ENGINEERING
DIVISION
325 L Street - Anchorage, Alaska 99501
Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR
WELL INSPECTION
REPORT
NAME
PHONE
W
,(/ L
!v f tit i✓ I r °uJ� ��
�� L'j a
❑UPGRADE
MAILING ADDRESS i
LEGAL DESCRIPTION
ivA
z Y T /z iUr 3
LOCATION
NO. OF BEDROOMS _
DISTANCE TO:
Well
fJv{ �y�
Absorption area
/ � jnSes�
Dwelling
%
PERMIT NO.
�i j
wQ
Manufacturer &7
C� / r
Material S�,� j
No. of compartments
H
Liq. capacity in gallons
IF HOMEMADE:
Inside length
Width
Liquid depth
DISTANCE TO:
Well
Dwelling
PERMIT NO.
= Z<
Manufacturer
Material
Liquid capacity in gallons
0
=
DISTANCE TO:LU
Well
Foundation
Nearest lot line
PERMIT N /
J U-
? U
No lines
�
Len h och ine
-1"9 2 'Z
'5.
Total length of It 's
Trench idth
inches
Distance between lines
Y
l'-
Top of tile to finish grade
Material beneath tile
Total effective absorption area
®
inches
!S 3
Length
Width
Depth
PERMIT NO.
U,
Q h
°• a
w
Type of crib.
Crib diameter
Crib depth
Total effective absorption area
LU
In
DISTANCE TO:
Well
Building foundation
Nearest lot line
w
Clas •
Depth
Driller
Distance to lot line
PERMIT NO.
J
w
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
f7 v
PIPE MATERIALS
SOIL TEST RATING
5
INSTALLER
sk. E 11 if
:3 E �rL
REMARKS
s -7C' 1C.1 G C>� -�, /�l c, T- o 2'/
ly
12.5
�/P1S �S�I�' � �� /� X19+"�77>Yi �-f�♦<lS ,.
5
I
I
I
e
APPROVED DATE LEGAL
7L���e"-,
1
iz-u i3 tnev. 3/ /8)
4041
9 91U � •!t
'.�
No. 3A16-5 . fP
�a .0 �.•...r' '`� r
1 hereby certify the following described property, LOT / , BLK
CIE,4Rl//EW SUBO/V/S/oN
Anchorage Recording Precinct, Alaska, has been surveyed by me, or at
my direction, and that the Improvements situated thereon are within the
property lines and do not overlap or encroach on the property lying adja-
cent thereto, that no Improvements on property lying adjacent thereto
encroach on the premises in question and that there are no roadways,
transmission lines, or other vislble easements on said property, except
as Indicated hereon.
It Is the responslbllity of the owner or builder, prior to construction, to
verify proposed building grade relative to finished grade and utility con-
nectlons and to determine the exlster.cs of any easements, covenants,
or restrlctlons which do not appear on the racorde4 s ,bdivii!on plot.
L -
q�.
SCHILLING
a
ASSOCIATES
7217 Arctic Blvd.
Anchorage, Alaska 99502
344-9694 3-19-7 724
ate: 4_ Z -7-
ca! e:
-ca!e: f^'
5 c7
r{..
SCHILLING
4-/, C Z_ j/G_i4J 31.-e L. 4W 1//i
V CHI LLI, r^!1V �I./'� JOB--- -
AfCtIC Blvd. SHEET NO. __.___.� OF
AnchIMs, Alaska 99502
kA 344-9694 349-7724 CALCULATED BY DATE �-�--
ASSOCIATES CHECKED BY DATE
SCALE
a
MWOK1 *091 N—s 1w Gomm Mn 01471
MQNICIPAL ITY OF AN RAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
825 L STREET, ANCHORAGE, AK 99501
264-4720
CA " - "-=; I -V a -4-,- a W a F;"e- -SL-
PEPMIT NO:
DATE ISSUED
APPLICANT:
ADDRESS:
(CONTACT PHONE:
ILEGAL DESCRIP
(LOT SIZE:
MAX BEDROOMS:
840344
05/15/84
WE:L-L- Fm-F=FRm i -r
NORTHWAY HOMES
2447 LOUSSAC DR.
ANCHORAGE.., AK 99503
349-2324
SUBDIVISION: CLEARVIEW SUB LOT: 1 -BLOCK: NO
SECTION: 24 TOWNSHIP: 12N RANGE: 3W
53709 (SQ.FT. OR ACRES)
5
LISTED BELOW ARE THE OPTIONS AVAILABLE TO
YOU IN DESIGNING
YOUR SEPTIC
SYSTEM. CHOOSE THE OPTION
THAT BEST FITS
YOUR SITE.
- - - - - - - - - - - - -
- - - - - - - -
T F:?- FE 1'4 IEF-1EB:
- - - - - - - -
FE C' -s
- - - - - - - - - - -
L4 - C., -' F=1' X
DEPTH TO PIPE BOTTOM (FT.)
4.0
4.0
4.0
GRAVEL DEPTH (FT.)
2.0
0.5
2. 0
TOTAL DEPTH (FT.)
6.0
4.5
6.0
GRAVEL WIDTH (FT.)
2.5
27.0
5.0
GRAVEL LENGTH (FT.
235. 0
53. 0
132. 0
GRAVEL VOLUME (CU.YDS.)
54.3
53.0
61.1
TANK SIZE (GALS)
1,500.0
1: 500.0
1,500.0
SOIL RATING (Sri. FT. e -BR)
188
188
188
II
GRAVEL LENGTH > 75 FT. REQUIRES MULTIPLE RUNS (NOT EXCEEDING 75 FT. EACH>
TANK MUST HAVE AT LEAST TWO COMPARTMENTS
CERTIFY THAT:
1. 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET
FORTH BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE OF.ALASKA.
2. 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH ALL MOA CODES AND REGULATIONS,
AND' IN COMPLIANCE WITH THE DESIGN CRITERIA OF THIS PERMIT.
3. I WILL ADHERE TO ALL MOR AND STATE OF ALASKA REQUIREMENTS FOR THE SET BACK
DISTANCES FROM ANY EXISTING WELL: WASTEWATER DISPOSAL SYSTEM OR PUBLIC
SEWERAGE SYSTEM ON THIS OR ANY ADJACENT OR NEARBY LOT.
4. 1 UNDERSTAND THAT THIS PERMIT IS VALID FOR A MAXIMUM OF 5 BEDROOMS FIND
ANY ENLARGEMENT WILL REQUIRE AN ADDITIONAL PERMIT.
.IF A LIFT STATION IS INSTALLED IN AN AREA COVERED -BY MOA BUILDING CODES,
THEN (i) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS -GUILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN.
I SIGNED
(APPLICANT
I ISSUED Blr
DATE:
DATE:
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501 LS LOG
• MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: V �T / /� y'� " DATE PERFORMED: 4-1c3—&4-
LEGAL
'1`-1c3—&4-
LEGAL DESCRIPTION: `- 07-(D -IJ
DEPTH 3Z Sirocv c�vc�Z SLOPE SITE PLAN
(FEET) OIZL,Arv[�5� �VFeoc^�/
1 -
2 -. ol�5o G/vF�2ozc"
5;/7/- ML
3
v
4
0
5 S; ��y S4hdc, cJtt<rC
C G fo M
6
7
8
r�
9-
10 10
11 WAS GROUND WATER
ENCOUNTERED?
12
13-
19
Date
0F• At�tr'®
14
.
O
c�
.' '• 0
■■■■■■■■
i #
'•4TH �,�*♦,
15-
o7690" W**'
--�
16
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• •.•...
• Robert D. Schiiling
CE - 1411 •' ra
'•.
17
�`
�fLo .•' �i' ay
18-
8
EME!
OMMIN
19
IF YES, AT WHAT
DEPTH?
MENNEN
Date
No
■■■■■■■■■■
Depth to
Water
Net
Drop
■■■■■■■■
IN
■■■■■■■■N
■
■■N.■.■.■■
■
�„■
�■■■
■.,ES'N
■FIBEli'IIMirMEN
■EMIME
NEEMINEMMEM
EME!
OMMIN
7-4-0• t ¢
/t1O L
O
P
E
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
3:00/.^.m.
20 I I PERCOLATION RATE 3y/ - /.4./Z— (minutes/inch)
u TEST RUN BETWEEN FT AND g FT
COMMENTS G/sem /�yJ�lSi /� 5 ui� S 'eor*r/
PERFORMED BY: �2p !/ % ��? l/� �y CERTIFIED BY: ;Rv—,d DATE: 4'-/� B�
72-008 (6/79)
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. OrS- ~,H3.- qo
GENERAL INFORMATION
Complete legal description ... C[¢.~rvi~
Location (site address)
Current Property owner(s)
Mailing address
Lending agency
Mailing address
Real Estate Agent
Mailing Address
COSA# O.~C,,}O /~'~."7
Expiration Date: ,.~ '- /~'-- / /
Day phone
Day phone 7_.~0-2.5(~0
Un/ess otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: _.~
TYPE OF WATER SUPPLY:
Individual Well []
Individual Water Storage []
Community Class ~ Well []
Public Water System []
TYPE OF WASTEWATER DISPOSAL:
Individual On-site
Individual Holding Tank
Community On-site
Public Sewer
[]
[]
[]
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site System's .Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of On-Site Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my. investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Address '205
Engineer's Printed Name
DSD SIGNATURE
\/ ^pproved for
Disapproved..
Conditional approval for
Phone
bedrooms.
bedrooms, with the following stipulations:
By:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
',~/'~~~0 rig inal Cert ifi cate Da te:
(Rev. 11/'05)
MuniciPality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343~7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
I Parcel ID: 015-
Legal Description:
A. WELL DATA
Well type Pr;~,¥{,'
Date completed ~owv~ Sanitary seal (Y/N) ~
Total depth ~0 E. Cased to ~0 ~.
FROM WELL LOG
Date of test ~'~. ~ v':' ~ ~A~ ~5
S~tic water level ~ ff. ~ ~
Well pr~u~ion ~ g.p.m. ~
If A, B, or C provide PWSID # ~
WATER SAMPLE RESULTS:
Coliform /~e.~, colonies/100mL Nitrate 4,23 mg/L
Arsenic: /VD ug/L date of sample:
SEPTIC/HOLDING TANK DATA
Tank Type/Material ~¢~or~ ¢
Tank size J500 gal. Number of Compartments
Depression over tank (Y/N)
Pumper m~
Foundation cleanout (Y/N) ~
Date of pumping 1'/'13 1TM
C. ABSORPTION' FIELD DATA
/v
-!'!S)O~ Soil rating (~orff2/bdrm)
I
ff.' Width $ ff.
Date installed
Length ' ~J
Total depth 9 fl:.
Date of adequacy test
Well Log (Y/N)
Wires properly protected (Y/N)
Casing height (above ground)
AT INSPECTION
Jll~/ 'l-otO
3-~ ft.
~, ,5 g.p.m.
Collected by: Lt~r$
,,/
{-t~ in.
Fluid depth in absorption field before test ~ in. Water added '{'50 gal.
Elapsed Time: ~t~t0 min. Final fluid depth ~ .... in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
Date installed iii3 - Il/5/lo°~J
Cleanouts (Y/N)
' High water alarm (Y/N)
Eft. absorption area ~ClO ~ Monitoring tube
t,t\ ~/~.otO Results (Pass/Fail)
System type Sl~,llo~
Gravel below pipe ~, 0 ft.
Depression over field
For 5 bedrooms
New depth '7.. in.
--~rSO g.p.d.
If yes, give date
Y
D. LIFT STATION
Date installed .../~._ ~ize in gallons ~./~'//~anh°le/Access (Y/N)
"Pump on' level at /,' in. "Pump off" level at /i~-- High water alarm level a.~t..~.
mm
Moo~ ala~ & imments?
E. SEPA~TI~ DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
I
Septic tank/lift station on lot JO0 t'
Absorption field on lot [00 It
Public sewer main /V/~
I
Sewer/septic service line ~..5 t
Animal containment areas /I,/,0, ~'SO'e')
On adjacent lots t,00
On adjacent lots
Public sewer manhole/cleanout /V/~,
Holding tank
Manure/animal excrete storageareas /V,o,
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation IOl+ Property line I0~+ Absorption field
Water main /I//A,
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Building foundation
Surface water A/.0.(IOO'J~ )
Wells on adjacent lots
Property line
Water Service line [O
Curtain drain AJ. 0,
Water main /V'/,~
Driveway, parking/vehicle storage
JO ~+
~F, COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name
COSA Fee $
Date of Payment /~./~/~:~
Receipt Number (;~)~_,~ ~' ~
(Rev. 4/10)
Waiver Fee $
Date of Payment
Receipt Number
............ SGS
SGS ReL# 110607400 l
ClientName Spurkland Engineering Printed Date/Time 11/16/2010 13:30
Project Name/# Clearview Lot I Collected Date/Time 11/08/2010 10:15
Client Sample ID Clearview Lot 1 Received Date/Time 11/08/2010 10:50
Matrix Drinking Water Technical Director Stephen C. Ede
Sample Remarks:
300.0 - Anions - MS recovery for chloride is outside of QC criteria. Refer to LCS for accuracy requirements. The matrix spike was
overrange for chloride.
Allowable Prep Analysis
Parameter Results LOQ Units Method Container 1D Limits Date Date Init
Metals by ICP/MS
Hardness as CaCO3 165 5.00 mg/L SM20 2340B C 11/10/10 11/15/10 NRB
Waters Department
Total Nitrate/Nitrite-N 4.23 0.100 mg/L SM20 4500NO3-F B 11/11/10 AYC
Microbiology Laboratory
E. Coli Negative I 100mL SM20 9223B A 11/08/10 DLC
Total Coliform Negative I 100mL SM20 9223B A 11/08/10 DLC
Private Individual Analysis
Alkalinity 110 10.0 mg/L SM20 2320B D 1
Aluminum ND 20.0 ug/L EP200.8 C 11/10/10 1
Antimony ND 1.00 ug/L EP200.8 C (<6) 11/10/10 1
Arsenic ND 5.00 ugfL EP200.8 C (<10) 11/10/I0 1
Barium 11.3 3.00 ug/L EP200.8 C (<2000) 11/10/10 1
Cadmium ND 0.500 ug/L EP200.8 C (<5) 11/10/10 1
Calcium 50000 500 ug/L EP200.8 C 11/10/10
Chloride 35.6 0.100 mg/L EPA 300.0 D (<250) 11/11/10
Chromium ND 2.00 ug/L EP200.8 C (<100) 11/10/10
CO3 Alkalinity ND I0.0 mg/L SM20 2320B D
Conductivity 383 1.00 umhos/cm SM20 2510B D
Copper 879 1.00 ugFL EP200.8 C (<1300) 11/10/I 0
Fluoride ND 0.100 mg/L EPA 300.0 D ('<2) 11/11/10
HCO3 Alkalinity 110 10.0 mg/L SM20 2320B D
1/09/10 LP
1/15/10 NRB
1/15/10 NRB
1/15/10 NRB
1/15/10 NRB
1/15/10 NRB
1/15/10 NRB
1/12/10 SDP
1/15/10 NRB
1/09/10 LP
1/09/10 LP
1/15/10 NRB
1/12/10 SDP
1/09/10 LP
.......... SGS
SGS Ref.# 1106074001
ClientName Spurkland Engineering Printed Date/Time 11/16/2010 13:30
Project Name/// Clearview Lot 1 Collected Date/Time 11/08/2010 10:15
Client Sample ID Clearview Lot 1 Received Date/Time 11/08/2010 10:.50
Matrix Drinking Water Technical Director Stephen C. Ede
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Private Individual Analysis
Iron ND 250 ug/L EP200.8 C (<300) 11/10/10 1
Lead 3.08 0.200 ug/L EP200.8 C (<15) 11/10/10 1
Magnesium 9700 50.0 ug/L EP200.8 C 11/10/10 1
Manganese 4.10 1.00 ug/L EP200.8 C (<50) 11/10/10 1
Nickel 2.38 2.00 ug/L EP200.8 C (<100) 11/10/10
OH Alkalinity ND 10.0 mg/L SM20 2320B D
pH 7.40 0.100 pH units SM20 4500-H B D (6.5-8.5)
Selenium ND 5.00 ug/L EP200.8 C (<50) 11/I0/10
Silver ND 1.00 ug/L EP200.8 C (<100) ll/10/10
Sodium 5410 500 ug/L EP200.8 C (<250000) 11/10/10
Sulfate 9.32 0.100 mg/L EPA 300.0 D (<250) 11/11/10
Thallium ND 1.00 ug/L EP200.8 C (<2) 11/10/10
Total Dissolved Solids 194 10.0 mg/L SM20 2540C D (<500)
Zinc 80.1 5.00 ug/L EP200.8 C (<5000) 11/10/10 !
1/15/10 NRB
1/15/10 NRB
1/15/10 NRB
1/15/10 NRB
1/15/10 NRB
1/09/10 LP
1/09/10 LP
1/15/10 NRB
1/15/10 NRB
1/15/10 NRB
1/12/10 SDP
1/15/10 NRB
1/11/10 JJR
1/15/10 NRB
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
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. # ~-~/,..C" L~'-~-.- 0~-~ HAA# .... ~-~C~L~C~'~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Location (address or directions)
(b) Property owner ~/~' ~./ Telephone: (home) ~-/~Business
Mailing Address
(c) Lending Institution ~ ~ ~/~%~/~'~) Telephone
Mailing Address
(d) Real Estate Company and Agent
Add ress
Telephone
(e) Mail the HAA to the fo owing address: (or check here ~31'if hold for pick up)
List------contact person and day phone number below:/. /~,,f.~4_),, ~ /f .'~'~t"t'~/'~'/'~/4
2. TYPE OF RESIDENCE
Single-Family ~ Number of bedrooms '~
3. WATER SUPPLY
Individual Well ~ Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
4. SEWAGE DISPOSAL
On-site [~' Public [] Community[] Holding Tank []
Note: If oommunity well system, must have written confirmation from the State Department of Environmental
Conservation attesting to the legailty and status.
72-025 (Rev. 7/88) Page 1 of 2
Aarow Pump & Well Service LLC
(907)346-9355
Inspection Report
12001 Graif
Well camera was ran down to 45' and no perforations were found or leaks found.
Brian Wille
Aarow Pump & Well Service
C)
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MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date zo—//
1. GENERAL INFORMATION
// S—,
(a) Legal Description (include lot, block, subdivision, section, township, range)
/3 /" K ' Lc f / 5e, z -q 7-1-Z N J231-�
Location (address or directions)
'.5-0 /{ la7 /1 u
(b) ' Applicant Name �7 K %e.?, 6/c Telephone: Home Business
Applicant Address
(c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Buyer ❑ ; Other ❑ (explain);
(d) Lending Institution Telephone.
Address /
(e) Real Estate Company and Agent
Address N A
i
Telephone
(f) Mail the HAA to the following address:
110111,
2. TCngle-Family
RESIDENCE
S C( Multi-FamilyOther
Ndrooms
3. WATER SUPPLY
Individual Well I;� Community ❑ Public ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
4. SEWAGE DISPOSAL
Onsite Public ❑ Community ❑ Holding Tank ❑
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attesting to the legality and status.
Page 1 of 2
72-025 (11/84)
t
5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DAT AND INFORMATION •
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Authority Approval shows that the on-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 14 CCS Telephone
Address /z CC' cti'e.,7 J � r � /�nc�c�kv, c /} � �✓ �J S� S
Date
IV,���F� 19 °a
®e a oe eooeese •eo0eaa�er
•roeo• 000seeoweo®io• •oaf
o LEROY C. RE D, JR. e �
ee CE v 2251 i �;°
e®e so' AV
A�G�!]gv®oe®oeeeeo G06
`f fat z�J��1�S►4�®L®��
6. DHEP APPROVAL
Approved for bedrooms by ate W
Approved _41)_Disapproved Conditional
Terms of Conditional Approval
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority
Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional
engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or
analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-025 (11/84)
MUNICIPALITY OF ANCHORAGE
. • DEPT. OF HEALTH &
ENVIRONMENTAL PROTECTION
MUNICIPALITY OF ANCHORAGE (MOA) h
HEALTH AUTHORITY APPROVAL (HAA) Ut,T ZU
CHECKLIST -FEBRUARY 1984
264-4720 RECEIVED
Legal Description: C /«wi'ew C, t / /3/uck
..SCS, Z!4 rl'zNA 3�
A. WELL DATA
Well Classification f r"' 4"Ik- If A, B, C, D.E.C. Approved (Y/N) 'VA
Well Log Present �/ ) Date Completed S_- Z�_ _ S_S7 Yield 5 GPM
Total Depth Y-3 o_ Cased to 60 Depth of Grouting
Static Water Level 38 Pump Set At
Casing Height Above Ground --.I Sanitary Seal on Casing &N)
Electrical Wiring in Conduit ea) Depression Around Wellhead (Y/tp
Separation Distances from Well:
To Septic/Holding Tank on Lot 170 �` ; On Adjoining Lots /O D '
To Nearest Edge of Absorption Field on Lot On Adjoining Lots toot
To Nearest Public Sewer Line A/ A
Cleanout/Manhole Al A
Water Sample Collected by
— To Nearest Public Sewer
To Nearest Sewer Service Line on Lot 67- Z Y
Date
Water Sample Test Results
Comments ACA-WlVelfm mecsvrn rerfi Waive— r-t.71Ld 1 v ADFC
l
B. SEPTIC/HOLDING TANK DATA
Date Installed ,Qof /3) 8Y Size /S OO
Standpipes (�I) Air -tight Caps &I)
Depression over Tank (Y/I0
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High -Water Alarm (Y/N)
Al I+
Separation Distances from Septic/Holding Tank:
To Water -Supply Well -K 4 O
To Property Line -7 Z'
No. of Compartments
A
0
Foundation Cleanout A)
Date Last Pumped Naw
; for Ai A
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
/z-;—
AI'A
To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage
Course.
Comments c�a<ve gra„ J 6y Iz)F'c
'v,
..
Page 1 of 2
r
72-026(11/84)
zzl
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata /B 6 C /6 Type of System Design PS Pc(
Date Installed _ or -IL /3 /qOid
l� Length of Field S
Width of Field Z Depth of Field
Gravel Bed Thickness G a
Square Feet of Absorption Area Standpipes Present O
Depression over Field (Y/� Date of Last Adequacy Test N*
Results of Last Adequacy Test N#
Separation Distance from Absorption Field:
To Water -Supply Well '?O
To Building Foundation 30
Lot N 4
To Water Main/Service Line / 0
To Stream/Pond/Lake/or Major Drainage Course _
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
On Adjoining Lots 30 +-
To Cutbank (if present) i✓ A"
00.4 -
Comments . U, , 9,WW�lyd c. -I - -
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
— Manhole/A ss (Y/N)
mp Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I ha to hecked, yerified, or conformed to/all MOA and HAA guidelines in effect on the date of this inspection.
Sign Date
Company MOA No. sr e6 U L�
Receipt No. QOl OQ-7�
Date of Payment /D -� I��VOF•Ay4, .�
Amount: $ Jr, • • _—
Page 2 of 2
72-026 (11/84)
0 MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
ION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
APPLICAT
1. General Information Application Date � 12-1
(a) Leeg)g1 Description (include lot, block, subdivision, section, township, range)
1� r� Y` �! 1 1� Sa�6 !3/oc k - -- L vf 7-1 l -J Se C. 2 Y
Location (address or directions)
( b) Applicants Name Da/&_ Tram �/e Y Telephone - Home Business 7S7
Applicants Address 7 ,? SC
(c) Applicant is (check one) Lending Institution ; Owner/builder l
Buyer E::l ; Other E—� (explain);
(d) Lending Institution Telephone
Address
(e) Real Estate Co. & Agent
Address
Telephone
(f) Mail the HAA to the following address:
2. ape of Residence
Single -Family Multi -Family
Number of Bedrooms �9_
3. Water Supply -
Individual Well � Community
Other (describe)
Public =
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal
Onsite Public Community Holding Tank
Note: If community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
Engineering Firm Providing Inspections, Tests, File Search, Data and Information
,w
As certified by my seal affixed hereto and as of the validation date shown below, I
verify that my investigation of this Health Authority Approval shows that the on-site
water supply and/or wastewater disposal system is safe, functional and adequate for
Tp
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 onsite water supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm lAy,
E.
C_ S
Telephone I6 IS -D L/
Address / �2 0 (0
LJ
r . . -ftN-1 � Q, S
Date LL ,/ I?
(ENGINEER SEAL)
6. DEEP Approval
Approved for Liz bedrooms By Z,
oe Al eta..
q C2
e
a
V' ®QC'o00 osa io ova o6 '
A $9 ,
le y C. Reid,
j
No. 2251-E ;
Ja
Approved V_ Disapproved Conditional
SMSCeLA �_'� J
Terms of Conditional Approval \k -'at d\ WPb6ft_L- 5/13
)T5' 11791 �5
W •
THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT—
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE—
MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK.
(DHEP SEAL)
RR4/ej/D18
[Page 2 of 2] 7-19-84
• MUNICIPALITY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH &
HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION
CHECKLIST - FEBRUARY 1984 'JUN 2 "' 1QR;
264-4720
A. WELL DATA
Well Classification P,� 1c If A, Bim, C, D.E.C. Approved (9/N)
Well Log Present�l) Date Completed ,.� - cM— 8�_ Yield —57
Total Depth o' eCased to Depth of Grouting NA NUT DN -
Static Water Level Pump Set At OnT n&�yj"t,
Casing Height Above Ground yS2L Sanitary Seal on Casing &)
Electrical Wiring in Conduit &N)
Depression Around Wellhead (Y&))
Separation, Distances from Well:
To Septic/Holding Tank on Lot On Adjoining Lots
To Nearest Edge of Absorption Field on Lot 9010 ; On Adjoining Lots
N t
To Nearest Public Sewer Line t�ky To Nearest Public Sewer
Cleanout/Manhole NR To Nearest Sewer Service Line on �Lot
Water Sample Collected by (r�� ; Date
Water Sample Test Results A _�S�`�S't�lleod2-� d
Comments ®1•i &tl-'� a10_. 4_eZ
B. SEPTIC/HOLDING TANK DATA
Date Installed 0 120 Size No. of Compartments
Standpipes &) Air -tight Caps &N)
Depression over Tank (Y&
Foundation Cleanout &/ J)
Date Last Pumped _. AJ A -<f L[h
Pumping/Maintenance Contract on File (Y/N) N ; for
Holding Tank High -Water Alarm (yo J� R Temporary Holding Tank Permit (Y�N Ain
Separation Distances from Septic/Holding Tank: r
To Water -Supply Well a C), © To Building Foundation 2.5�
To Property Line 7a To Disposal Field
To Water Main/Service Line rV To Stream, Pond, Lake, or Major Drainage
Course N A
Comments (Dc-00_44_,th- &AALe�
`/ Page 7 of 2
I� �.
72-026(11/84)
C�_e C
. I C C4ct_&_vt
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata 1 E E u (/ m Type of System Design
Date Installed ,�' ��� Length of Field -IAMMLYI
i
Width of Field I -a 4 6?7 Depth of Field r
Gravel Bed Thickness
I S,� a
Square Feet of Absorption Area � Standpipes Present6N)
Depression over Field (Y&
Results of Last Adequacy Test W N
Separation Distance from Absorpti� Field
� U
To Water -Supply Well b To Property Line Io
To Building Foundation'. To Existing or Abandoned System on
,+V � 41-�rY
Lot � 1k ; On Adjoining Lots 3® t a6ew`
To Water Main/Service Line To Cutbank (if present) NA *.Lo+
To Stream/Pond/Lake/or Major Drainage Course �lFaC�
To Driveway, Parking Area, or Vehicle Storage Area
yi,� /
Comments (D wCic- Cti '
//
Date of Last Adequacy Test �J k < Z�
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
** Check Permitted Bedroom Rating Against HAA Request **
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed �NLQ��-� — Date
Company ALC=s MOA No.
Receipt No.
Date of Payment
Amount: $
Page 2 of 2
72-026 (11/84)
u
wm 20, IM
AbIft "Mmotaf I
smfv�9.-.•
IZO Vest, 3rd A"=Ws Suitt B
Alli@ wap.6 Alaska 99503
gra iktWer FfWzental Separatia: betmm Well and Septic
Tames Let It Marview Subdivisi2ps Vie, Alaska
274-2S33
Dtar Sir:
.-IftlWrtment has rev i urod the snNett we iV er regm t mW hereby ns ives
l *42.ental separation be the Well Wad septic, tank to 90 feet r
AwA :subject property far a 5 bedriko single fmi y residence only.
Sincerely,.
District Engimv
`llL
//-/ Z S Q rp 4(,j ,
;IGY�{-
a. v,.' Ae_
�_Q' CIr- /'S
---kd 4.0
7; a
ALASKA ENVIRONMENTAL
CONTROL SERVIC INC.
1200 West 33rd Avenu uite B
ANCHORAGE, ALASKA 99503
(907) 561.5040
*MEET NO. f OF
CALCULATED BY �� DATE
CHECKED By
DATE