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PITZER LT 1
Pitzer Lot 1 #090 - 021-55 Rick Mystrom Mayor Municipality of Anchorage Department of Health and Human Services 825'L' Street P.O. Box 196650 Anchorage, Alaska 99519-6650 htlp://www.ci.anchorage.ak.us Permit Number: #SW 930056 Date of Issue: 3-25-03 Date Started: 7-12-03 Date Completed: 7-13-03 Is well located at approved permit location? ® Yes 0 No Legal Description: Pitzer Lot 1 Properly Owner Name & Address: Edward Powell Jr. HC 52 Box 8595 Bird Creek, Alaska 99540-9601 Parcel Identification Number: 090-021-55 Borehole Data: Depth (fit) Method of Drilling 0 air rotary 0 cable tool Soil Type, Thickness & Water Strata From To stick-up 0 2 silty gravel 2 53 gravelly silt 53 101 silty water sand & gravel 101 140 Casing type: steel Wall Thickness: ifiQ inches Diameter: ¢ inches Depth: 22feet Liner Type: Diameter: inches Depth: feet Casing stickup above ground: 2 feet Static water level (from ground level): &jfeet Pumping level: 140 feet after 2 hours pumping QQ gpm Recovery Rate: QQ, gpm Method of Testing: airlift Well Intake Opening Type: 0 Open End ■ Open Hole • Screened Start feet Stopped feet ❑ Perforations Start feet Stopped feet Grout Type: bentonite # 8 Volume: Lke Depth: Start Q feet Stopped Z feet Pump: Intake Depth feet Pump size hp Brand Name Well Disinfected Upon Completion? 0 Yes ❑ No Method of Disinfection: Comments: Well Driller: Alpine Drilling & Enterprises PO Box 110496 Anchorage Alaska 99511 Attention: The well driller shall provide a well log to the property owner within 30 days of completion and the property 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 WATER SUPPLY PERMIT Renewal Permit Number: SW030056 Legal Description: PITZER LT 1 Design Engineer: 0000 None Required Owner Name: Edward B. Powell Jr. Owner Address: HC 52 BOX 8595 BIRD CREEK , AK 99540-9601 Date Issued: Mar 25, 2003 Expiration Date: Mar 24, 2004 Parcel ID: 090-021-55 Site Address: Lot Size: 37420 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: Disposal Field ❑ Septic Tank n Holding Tank ❑ Privy n 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 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:c. -� a •✓ Date: 3/ 2 S 103 Issued By: Date: *,,,, 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 WATER SUPPLY PERMIT Initial Permit Number: SW030058 Legal Description: PITZER LT 1 Design Engineer: 0000 None Required Owner Name: Edward B. Powell Jr. Owner Address: HC 52 BOX 8595 BIRD CREEK . AK 99540-9601 Date Issued: Apr 01, 2003 Expiration Date: Mar 31, 2004 Parcel ID: 090-021-55 Site Address: Lot Size: 37420 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 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 ( 18AAC80 ). 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 awmi P ve744- Date: 4/1/03 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AIC 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. 0q0- 02 1-5 Property owner(s) Ert,1RR r> I7v. I DWELI- .52. Mailing address (1) /4C- Sz 13 or as95 1-11Z0 02F -Cg Mailing address (2) Legal description (Lot, Block & Sub'd.) Lo -r f Pii/-26-k Permit Number SW 03009573 Day phone (90 i) 653 -199'4 )J1 K 99sgr , Zip Code Legal description (Section, Township & Range) Lot Size 31-)42-0 Acres/Sq.Ft. THIS APPLICATION 1S FOR: Sewer Only Sewer and Well Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub Swimming Pool Therapy Pool Number of Bedrooms 3 Well Only Water Storage Jacuzzi Water Softening Unit 0 certify that the above information is correct. !further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Signature of property owner Rfri4Hifit horized agent) Permit Fees: 15171 " Date of Payment: 3f/ij/07 Date of Payment: Waiver Fees: Receipt Number: 72 ISO (Rev. 12/00) Receipt Number: George r. IPuerch, Mayor 2/3/2003 Anchorage .Municipality of Anchorage. had All4merica City Building Safety Division 1111111 2002 Edward B. Powell Jr. HC 52 Box 8595 Bird Creek AK 99540-9601 Subject: Expired On -Site Water and/or Wastewater Permit. Permit Number: SW020015 `Legal Description: Pitzer Lot 1 Dear Edward B. Powell Jr.: An On -Site Water/Wastewater Permit, number SW020015, issued by this office for a single-family system, expired on January 31, 2003. This permit was valid for 365 calendar days. If this was a well permit and the well has been drilled, a well log must be sent to this office for documentation of the installation and to close the permit. If this permit was for a wastewater disposal system, an original as -built inspection report must be sent to this office for review, approval and documentation. This as -built inspection report must be signed by the licensed Professional Engineer who inspected the installation of the system. As -built inspection reports are required to be submitted within 30 days of the completion of the system. If no system was installed under this permit, and you are still planning to install a well or wastewater disposal system, a new permit must be obtained from this office. When applying for a new permit, the fees are: $320.00 for a wastewater permit and $120.00 for a well permit. If you have any questions, please call this office at 343-7904. Since 4-71/6,seleo,)4 Jatm$s Cross, PE Manager On -Site Water and Wastewater Program Enc: Copy of permit P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: (907) 343-8301 • Fax: (907) 343.5200 4700 South Ilragaw Street • Anchorage, Alaska 99507 hl tp://www.ci.anchorage.alcus 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 WATER SUPPLY PERMIT Initial Permit Number: SW020015 Legal Description: PITZER LT 1 Design Engineer: 0000 None Required Owner Name: Edward B. Powell Jr. Owner Address: HC 52 BOX 8595 BIRD CREEK , AK 99540-9601 Date Issued: Jan 31, 2002 Expiration Date: Jan 31, 2003 Parcel ID: 090-021-55 Site Address: Lot Size: 37420 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy 0 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 ( 18AAC80 ). 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: Issued By: umn 19Arql Date: 25/OL Date: / /3 //o z Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and 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. tg i7 -0/91/4_1 - G Property owner(s) ltoA-ILD B. Po of at_ tea., Day phone (90 7) G 5-3 -my Mailing address (1) F%c 5 i Bok G5"YS� RRb rZCCK /4 K 99c1/46 Mailing address (2) Zip Code Legal description (Lot, Block & Sub'd.) Lor 1 A ra ER Permit Number SW02001 r Legal description (Section, Township & Range) Lot Size .37 / 242.& Acres/Sq.Ft. Number of Bedrooms 3 THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well ❑ Water Storage Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub 0 Swimming Pool 0 Therapy Pool ❑ Jacuzzi Water Softening Unit 0 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. (Signature of property owner authorized agent) Permit Fees: 0 15 - Waiver Fees: Date of Payment 1 - 3 0 - 0 2— Date of Payment Receipt Number: _ / S / 6 2 Receipt Number. (Rev. 12/00) . LOT 17 siDGuELopco 10' U1IUTY EASEMENTS • •wi twit) ... :NEW SEPTIC TANK SEPTIC VENTS (TY, P) •LOT �.•• AP Sup I'r :dob ►, i • •qr.� Or fa ;'4't. 1 " • •• •• LOT.:'4 . '`::i -It PITZER.. SUBD. • NA" NY .w.., to eq AUdtOa11j4:0:14.1111: a 14 , LSK 1 t' 7$ •.11fraaa, U11L BOX 1 H�'R 1'HAVE SURVEYED LOT 1••PITZER SUBDIVISION SHOW ABOVE. MD THAT No ENCRoACIWENTS :. EXIST EXCEPT AS INDICATED. -11' IS THE RESFONSIBILRY 01 THE OWNER TO DETERMINE • • • THE" =TAME OF ANY EASSWi?S. COVENANTS. ..OR RESTRICT/OHS. WO DO ROT APPEAR OR THE -.RECORDED SUBDMSION PLAT. UNDER NO GRCUMSTANCES SHOULD ANY DATA HEREON ..8E USED FOR CONSTRUCTION. OR FOR ESTABU5M1NC.BOUNDARY•OR.FENCE UNES. SEPTIC SYSTEM INSTALLED 1-10-92 •ASSU11T' AMENDED • 1-21-92 • • • .•LOT3 '.F ITZER SUBD: • 2O' ACCESS'EASEMENTS • NOTE; A1.6 3EAR1rIfit'Ij `PISTRAt<RS • REGGVZD .1i-leO,UaA7Jc.V .. . : ASBUTLT : • , LOT 1 PITZER SUBDIVISION. ..amu • HIGH_: PHUKkN .:• *, CONSULTING .ENGINEERS • : 203 WEST 1501 AVENUE, SUITE 104 •: ANCHORAGE, •AK 99501 • Date Scale • Grid • Drawn by V.O. • . CMA . H91410.4 10-0391 1"=50'. ''4759 > • Checked by F.B. • ` MJH .:. . H-111 CO "EBSVM 9 UNVS N 0 0 """1330N3 - 31V4 d31HVnS - alta kiD N N O O V V CO CO ONISVO dO MX 31(INIW M3d'S1v0 N O 0 v 1 8 OWNER OF LAND MR• DALLAS PITTSER ADDRESS $IRDCJtEEiS Li N3tvM do 13A31 auVJS O' U 113M 10 H1430 N O z461 souls Nom Affioloedg, m 8 DOI ONI1111L0 AllYG• A--C� C-atL& ) Z v14- Lor ( P(rae-e_ Sulativi510,) too An:Lid W. riga pta-f-a-tta Weil ls0 ttet _news44- cok+uk Ler ) Pt -tree Sbbi✓(so,J, 44 vn.4wtee e ti , as Airrin.1 GthiLA foo Z.81.lif Municipality of Anchorage Page I of DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION H91410 P.O. Box 196650 0 Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SKi 9 fD3-75 PID Number:. O c' 00 2-155 Name: STE\/� M4 - Wastewater System: _ New _Ki upgra �" Address: jc 5 . f3ox f35a°f Bt20 GIC-. ABSORPTION FIELD Phone:_ ('.O G .-S- Z (v 17 No. of Bedrooms: 3 0 Deep Trench 0 Shallow Trench 0 Bed Mound ❑ Other LEGAL DESCRIPTION Soil Raring: • 4 GPD/Sq. Ft. To: Total Depth Irom original grade: Gravel depth beneath pipe Q . g Ft Lol: I Block: Subdivisions SITZ E_fZ Depth to pipe bottom from original grado: O Ft. Township: 10� Range:Section: 1 Fill added above original grade: Z.S FL Gravel length: / S%.G FI WELL: WELL'+�t E i it ❑New ❑Upgrade Gravel WIPTA 2© Ft. Numberol lines: L}" Distance betvrcenlows. S Ft. Classification (Private, A,B,C): � l'/ C Total Depth:CD 12,0 FI. Cased To: m 12.0 FL Total absorption area: j 1 72r) 12.5 SQ. Ft. Pipe material: PVC, C. - 1 Driller: 0 Pfrldt4 Jt<Q.SE.Y (*(LL1Nr; Dale Drilled:C.) °1-20-7 Y, Static VJatof_Level: (06I '© Ft. Installer: CSWA11:2 Date installed: I -• o c - ct 2 Yield: 2C)kj' GPM Pump Sul at: © 10(19Ft. Casing Height Above Ground: 2 1 FI. TANK SEPARATION DISTANCES Septic ❑ Holding ❑ S.T.E.P. To From Soplic Tank Absorption Fiala Lilt Station Homing Tank Public/Privalo Sower Linos r�er-:�i� Man^ulactu�%VgA /`t xi/W6E T/1VI . Capacity in gallons: 1OQd Number of Compartments: 2. Well 12-1 1 I U(p1 N -A N -A N -A Malarial: STEEL Surfwere N/4. PI /AN. P- -- LIFT STATION I_ot1 Line 1 1 1 Q.1 ._-. ^- Sizo in gallons: /�J /Q Manulacturor: -- Foundation 1 3 8 i co �,.• .--4 "Pump on" level al: -_ 'Purim on" level at: Nigh water alarm at: Curtain�/� Drain -- P • Pump Make &Model Electrical Inspections performed by: -- " Remarks: (, et-oP�1& 7-p AOOEO c9VE.r2 -7474Q BENCH MARK ENTIRE srsTlEm fA1 SP 1492 ) RE42A0ri..0 A SEE -OE P. Location and Description: V E-S`t' 11'(Loe CDg. Assumed Elevation: If:7.12 fI. ENGINEER'S SEAL �jx �wr��ri . 'y y�., o 6'!!lB OVO!® Inspections performed by: ..,6g -..,6g --t-,°-1-• A I AMS Dates: 1st 1.-43'-'9.2••1.-43'-'9.2•• !ttJ $ 4 2nd 1 R-92 El -3r4 1-10- 92. .,.E . .00EP •; Don,.!.' De„ rx,,_, !iff Department of Health and Human Services approval ,...,.„1. C`^_:r_rJZ.--1,r:1z_Ci i ,----.� '/2 y Reviewed an6 approve6by��--1--a- (Ua-14' Date: 7-4— i_ =�' '.gj .o 1-r,vnv err r' rlt.F-' 07 Nal, Ser/2EPL CE10 8-1b-90 Permit No SW910375 P.O. On—Site Page of 4 - Municipality of Anchorage Department of Health and Human Servi.ces ENVIRONMENTAL SERVICES DIVISION Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 Wastewater Disposal System/Well Inspection Report 1-I(311io Legal Description: Lot 1 PITZER SUBDIVISION EXIST. TAN CRUSHED BACKFILLED PID No 09002155 SCALE 1"=20' PARKING AREA J� . PWSID No. 217542 C TANK' I chv • • SOLID PVC,CTYP) 104 110 LOT .1108 ........ ............ .... :. 106 '76.".,.(TYP) 102 C\ EXIST. SYSTEM =Kr' .\` ABANDONED IN PLACE \\\\ ....... 100 S OR 59. PROPERTY CORNER 1 1/2" AL CAP ON 5/8" REBAR TBM ELEV =1100.00' POINT ELEV • A INV: TANK INLET 105.8 B INV, TANK OUTLET 105.7 C INV. CO 102.3 D INV, CO 100.0 E INV. CO 100.0 4" PERF. PVC (TYP) LOT 4 PAF . AL c.,44, C: * 0.... TH o•••• 00730 •DENNIS DEE H; 43i $PC!' •o• CE 5807soo6c,� R 1 a Htofessaon o® it 72-013 A (2/91) MOA 25 `~J RECORD DRAWING AS PER ENGINEERS MEASUREMENTS 1-10-92 Filet 410 Purmit No S(.J`)l f O.Z Page ? „� Municipality of AnchorageG141n Department of Health and I-ILirnan Services ENVIRONMENTAL SERVICES DIVISION 1-1 P.O. Box 196650 • Anchorage, AK 99519--6650. Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Doscrlption; Lot 1 PITZEP SUBDIVISION PID No. C)`jajZI S • 1.2 uIJ A I.'/.1I ;.;n kr q' 3 J uJ '` W J 0 P q O lei Uuo� 7 L �, Vu� . .E' , v; yr � I .J1 .-- \ NE lilt {p �I �• / J. n 0 � . . .I , , . . , to ti 7/ 111 L[ i t+4 cjrZ (f) r - Lys,'. iJ .0.0.06004,n•i� 00000.0 Do;m'.n D.a CE - 41:8.07 �y Permit No Swami 1 ",'75 f'a�� n1 1,4unicipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION l-i`llito P.O. Dox 196650 • Anchorage, AK 99519-6650 • Tul: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Dnscriptlon` Lot 1 PITZER SUBDIVISION 76-011 A (i/II) IMIII i:3 PID No. oc'ioa zt 5 �� LI. ;.1 . , .14.1 Li it:Jz 1 f U. is , q. !;'tai 6,0 O IrU QU.si1'yu1 Z2 J 114, GI Ili. Y1i IW S.pi. PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW910375 DATE ISSUED:12/13/91 DESIGN ENGINEER:HIGH, PHUKAN & SORENSEN CONS. ENGRS EXPIRATION DATE:12/13/92 OWNER NAME:MATTER STEVEN P & OWNER ADDRESS:HC 52, BOX 8509 BIRD CREEK, AK 99540 PARCEL ID:09002155 LEGAL DESCRIPTION: PITZER LT 1 SEC 9, T10N, R1W, SM LOT SIZE: 37420 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: 1. THE ATTACHED APPROVED DESIGN. 2. ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65 AND THE STATE OF ALASKA WASTEWATER DISPOSAL REGULATIONS (18AAC72) AND DRINKING WATER REGULATIONS (18AAC80). 3. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY: (47,4;e1 -744__C DATE: ( 7 43 C. DATE: Permit No. Page — of N9IaiJo.I Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 u Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well inspection Report Legal Description: Lot 1, Pitzer Subdivision PID No' SITE NARRATIVE Lot 1 of Pitzer Subdivision is bordered by three other lots (Lots 2-4) which were part of Lot 31's subdivision. Of these three lots, only Lot 4 has a well on it. That well is over 155 feet from the property line, and would be over 165 feet from the proposed system. This is considerably outside the required well radius. In fact, the proposed system would actually be further away from the well on Lot 4 than the existing system. Lot 2 shares the well with Lot 1; however, if Lot 2 were to install a well, there would be ample room to keep it over 100 feet away from the client's proposed system. Should this occur, it would also change the client's required well radius from 150 feet to 100 feet thereby allowing the proposed system to be placed without a waiver. Of the other lots which border Lot 1 (Lot 17, 18, 19 and 32), only two have wells according to records from the Department of Health and Human Services. These wells are over 400 feet from the client's proposed system so they will not effect the approval of the waiver whatsoever. Wells -- No impact on adjacent lots is anticipated from this system. Wastewater Systems -- No impact on adjacent wastewater systems is anticipated from this system. Drainage -- No impact on adjacent wastewater systems is anticipated from this system. All fills will be sloped to drain in the direction of the natural drainage. System will receive topsoil and seeding to prevent erosion. NOTE: A well radius waiver has been applied for from ADEC which would reduce the required radius from 150' to 106'. This waiver has been verablly approved and the waiver will be recorded at DI -111S as soon as it is completed. l' -UI n Noll Man;. Permit No. k4 1 Page of II Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 e Anchorage, Alaska 99519-6650 e Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Legal Description: L0 T 1 P ITZ E(L SL.tgpiVISION PID No S Y STr= m O E S I CIA( C -A 1.- G L.1 LATI O /J S 1. r1 U. fro ons g — 3 Z • USE mount() A6Sc0R-P. A(e-CA (tk 6r=pKooms)(i E,tAt.-(Ort4s/BK) movn10 APP. (GATE usE 4 Ir.LSTALI, w �3 �( l5°) 7. 1125 F7 .4 Zo' K SIA.S 113p rT PTtc- TAN. V-. 1pC?Q 9hl S. DLJE. 1-11C4t1 Ci(Lour,LD INATtre, Bcaroo-\ of Sr S7 PLACE -0 AT Ex- (STrfJC,. (zourg0 LE tr 2.2.13 WILL_ 6E gee A-GLc- LA'CELL A -S (LE!? PtLTIE(1- SA -ALD TABLE 1 WASTEWATER APPLICATION RATES FOR SUBSURFACE DISPOSAL FIELDS Percolation Rate min./in. 0 - 1 1 - 5 " 6 - 75 l 16 - 30 31 - 6 - greater than 60 filter layer 0.013 A WO l) ACOA: Mound System or Bed Application Rate qpd/sq. ft. Not suitable 0.8 0.4 0.3 Not. suitable 0.7 Permit No Page of 11 MCi4)o.I Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: _ Lot 1 PITZER SUBDIVISION PID No. 1"=40' LOT 32 . ABANDON• EXISTING SYSTEM . 1 . , I1 I I I / I LOT 18 LOT .1 PITZESUa3. GAR. DRIVE 0 . • WELL, • • • • • • • . L.OT.2 . 1 PITZER SUBD. 1 � I \ I . 1 I —110 30' PERC TEST RADIUS' (TYP) 108 . I 1 � I ' 1 106 10' SEPARATION ABANDONED EXIST STYSTEM'• 2-013 A (2/91) HOA 25 LOT 4 PITZER SUBD. '104- . -1p2 L PROPOSED MOUND SYSTEM (20' X .56.5') SEE•SHEET 4 OF•11. . FOR DETAIL & DIMENSIONS 10' PROPER Y LINE OFFSET TP TEST PIT AND PERC TEST DoY,71O iJ CE - re 117 ±09 oa9``�0 0e CG�A56'' FIL . DI HS. Dlock. Sup Permit No Page 4 of II 1491,410. I Municipality of Anchorage Department of Health and Human Servi.ces ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: Lot 1 PITZER SUBDIVISION PID No SCALE .1":=20' • , N II, s �+ EXIST. TANK SEE NOTE 7 r 110 108 4" SOLID PVC (TYP) see NoTE• 56' ` . 6" •` EXIST. SYSTEM TO -- " BE ABANDONED S' (TYP) 4" PERE. PVC (TYP) LOT 4 PITZER' SUED, /2-018 A (2/91) HOA 2S 106 2'-6" (TYP) "1a4..... - 102 r// _ MONITOR TUBE ceediit It 1011-1S. Ulocki Septic Permit No Page ` H. r f 11 .9t4/0.1 Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 o Anchorage, AK 99519-6650 • Tel: 343-4744 On -Site Wastewater Disposal System/Well Inspection Report Legal Description: Lot 1 PITZER SUBDIVISION PID No • nL •0 k 2 m • ur 0' I 4-019 n (2/vU ruin 23 (Ali MIS. litu Spic Permit No Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Popo-- of i i4,010.1 Legal Description: Lot 1 PITZER SUBDIVISION • • • /1J UI UINISYloClo Siy1K Permit No Page—_ of 11 1-1914P.) Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tei: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: Lot 1 PITZER SUBDIVISION PID No EXIST. TANK SEE NOTE 7 r 1000 GALSSEPTIC TANK CLEANOUT (TYP‘, • EXIST. SYSTEM TO BE ABANDONED SCALE .1"=20' '\ • 110 • \ • 4" SOLID PVC (TYP) p `1 �.ff7 ti. • 108 106 (TYP) 5 (Tr) _ _ ......... 102-, 4 PEI 7 MQNITOR TUBE Finlisk DE cc TouzS SEE NbTE= q LOT 4 PITZER. SUBD. /2-017 A (2/'/L) HOA 27 S.[�� 16LO(' itt 9• .J=f 6-6 06 I(u DIIIIS. 9locki Septic Permit No Page - ca II Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 o Tel: 3.43-4744 On—Site Wastewater Disposal System/Well Inspection Report I49t4t©• Legal Description: Lot 1 PITZER SUBDIVISION NOTES: PID No. 1. All construction shall be in accordance with Chapter 15.65, Wastewater Disposal Regulations of the Municipal Code, as currently amended. 2. Install new 1000 -gallon septic tank. 3. Site topographic survey conducted by I-IPCP on 10/3/91. Existing structures, wells, septic systems observed within 200 feet of proposed trench site are shown on design drawings. 4. All pipe shall be PVC conforming to ASTM D3034 or approved equal. 5. All insulation board shall be DOW HI -30 lnsulboard or approved equal. All thicknesses shall be 2" minimum. Center insulboard width over bed, pipes and septic tank. 6. Any deviation from the design must be authorized by the engineer prior to its incorporation into the system. 7. Contractor/owner shall abandon existing septic taiik in a manner approved by State and Municipal regulations, laws and guidelines (i.e., crush and backfill after being pumped). 8. This design is based on soils and percolation data conducted by HPCE on 10/9/91. 9. Slope all till material to drain at 2% min. slope, and in such a manner that ponding at or near the drain field does not occur. The lill shall be left 6" higher than shown to allow for settlement. 10. Material usecl as fill shall be clean and free of organics, trash and construction debris. 11. All excavation depths are advisory. They are to be verified and may be modified by the engineer. 7e-017 A (2/Y) IkIA 23 r1Y1 rI.i5 J114C11., 1.g .c Permit No Page_ `� q 11 14 91410.1 Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description: Lot 1 PITZER SUBDIVISION NOTES (continued): 12. All pipe connections to the tank shall be mechanical Calder couplings or approved equal. Cleanouts shall extend a minimum of 12" above the final ground elevation, and equipped with airtight caps. 13. Contractor/owner to locate all underground utilities, property lines, existing water wells, water ways, surface and subsurface drainage facilities, lakes, ponds, and other facilities requiring separation distances from the proposed septic system. Notify the engineer of any observed conflict. 14. Stake alignment of system with markers showing the protective distances from wells and other bodies of water. 15. Install the tank as show on the drawings. Record the inlet and outlet elevations of the tank. Tank shall be placed on undisturbed native soil. 16. Excavate the absorption field. Bottom of excavation shall be level and scarified. Record elevations of beginning, middle and end of each line. Construction equipment shall not operate on the floor of the excavation. Any material compacted by the operation of the construction equipment shall be removed and replaced with uncompacted materials. 17. Place the sewer rock to the specified depths. Do not contaminate rock with native materials or spoils from excavation. Level rock surface to ± 1" prior to installing the perforated pipe. 18. Cover the distribution pipes with rock, and cover the excavation with insulation before backfilling, 19. Record the finish ground elevations at the beginning, middle and end of each line. 72-017 A (2/VI) MIA Woc.iu sepuc. Permit No Page—1. _f 1 Municipality of Anchorage Department of Health and Human Services ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, AK 99519-6650 • Tel: 343-4744 On—Site Wastewater Disposal System/Well Inspection Report Legal Description; Lot 1 PITZER SUBDIVISION NOTES (continued): PID No. 20. Contractor shall notify the engineer 24 hours prior to commencing with construction. A minimum of three inspections are required. The first inspection shall be of the subgrade, prior to placing levelling sand. The second inspection shall be after the placement gravel, standpipes, distribution piping, tank and other components as specified. The third inspection shall be after the completion of the work. 21. Contractor shall deliver to the engineer a set of red -lined drawings showing all data as specified in Sec. 15.65.13.2, 3, 4, 5, 6 of Municipal Wastewater Disposal Code within ten days of final inspection. (-1 47(410. 7d-013 A (2/'7l) ruin .0 fru 1111$, Y4.o,, SwpIK Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST � • PERFORMED FOR: 5T.41.S. ATTE-ie- DATE PERFO •t' Woven /0 9/t� Township, Range, Section: T totJ (L, 1 IJ C. S.M. LEGAL DESCRIPTION: LOT f PtrZP2. SUd(). 2- 3- 4- 5- 6- 7- 8- 9- 10 11 - 12- eFEETI o. 4°o O o' ' D o 0. • 13 - 14- 15- 16- 17- 18- 19- 20 - 0R4ANIG. LAYell- S1L71'- 401AVEL WIWO (Qm SLOPE WAS GROUND WATER YE S ENCOUNTERED? IF YES, AT WHAT DEPTH? S I L 4 0 E Depth Io Water Aller blundering? �1- . ZS hale. 11•-12-9 SITE PLAN N SEa S (TE P LANI. Reading Date Gross Time Ne TUT e (B1u.4) Dopth to Water 41,12.5 — Net Drop .' to -9 - t t 9:DQAw. 30 1.815 12 g " 9: SQAW\ 10:00A1h 3 a C7 A.1'ZS 4,167s' 1.3'75 1.3125" LI` 1+ I/ PERCOLATION RATE 2•Z•• (minutes/Inch) PERC HOLE DIAMETER `o TEST RUN BETWEEN ' FT AND 2, �� FT COMMENTS PERFORMED BY: l'R` PO TN14 j`79 CERTIFY THAT THIS TEST WAS PERFORMED IN DATE: it -/o-9/ ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE 72-000 (Rev. 4/85) SENT RY:ADEC ANCHORAGE ;12-13-91 1 4:32PM ANCHORAGE/WESTERN DO- 2773177:# 2 WALTER J. NICKEL, GOVERNOR (907) 583.6775 RECEIVED DEPT. OF ENVIRONMENTAL. CONSERVATION Anchorage District Office 3601 C Street, Suite 322 Anchorage, Alaska 99503 December 9, 1991 Carl Abrams High-Phukan Consulting Engineers, Inc. 203 W. 15th Ave. Anchorage, Alaska 99501 Subject: Lot 1, Pitzer Subdivision, Separation Distance Waiver Application, ADEC Project Nurnber 9221 -WA -016 DIEL 13 1991 Municipality of Anchorage Dept. Health & Human Services Dear Mr. Abrams: This is in response to your submittal of November 14, 1991, requesting a waiver for a separation distance of 106 feet between a Class 'C' Well and an on-site wastewater disposal system. I have reviewed the submitted Information and have the following comments. Based on the submitted information, It appears that the proposed well to absorption field separation distance is marginally acceptable. Therefore, In accordance with the provisions of 18 AAC 72.035 and 18 AAC 80,30, the Department Is waiving the separation distance for both the septic tank and soil absorption system, to 106 feet, under the following conditions: 1) The septic tank will be located a minimum distance of 106 feet from the well and roughly between It's present location and that of the proposed mound system. 2) The septic tank will be a two compartment design with water tight connections and will not have been previously used. 3) Sampling of the well water for Nitrate and Collform Bacteria contamination will be required in the month of May on an annual basis. Due to the monitoring requirements of this waiver, a Public Water System Identification (PWSID) Number has been assigned to thls Public Water System. The PWSID Number for this water system is 217542, Please remember that the PWSID Number assigned to your water system will need to be on all analytical data submitted to this Department, so that the results will be properly filed and the waiver will remain valid, In addition, please complete the enclosed "inventory Update" form and return It to this SENT BY:ADEC ANCHORAGE :12-13-91 1 4:32PM ANCHORAGE/WESTERN DO-+ 2773177;# 3 Carl Abrams 2 office so that this water system can be entered Into the This letter constitutes the Department's approval of the distance. This approval does not Imply the granting of nor obligate any state, federal, or local regulatory body \authorizations. Thank you for your cooperation with this Department. please do not hesitate to contact me. December 13, 1991 Drinking Water Database. above mentioned separation any additional authorizations to grant required If you have any questions, Sincerely, Byron Roys Environmental Engineer BR/of Enclosures: As Stated co: John Smith, MOA/DHHS w/o enclosures '(,"1 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.�� .-r 7fv// iLI1-07/;-:g PHONE �)9 ❑ NEW XUPGRADEVA MAILING ADDRESS _ CO A J(f9 3/0 (?t -E<, fix -s=/6, LEGAL DESCRIPTION Le / 131-0 eke I)/7-2 -ie s06. -7---0,Al ,e/d sCe`- `j LOCATION , 54--/.14-k8 //p..1 NO. OF BEDROOMS 7 SEPTIC TANK DISTANCE TO: Well / /J (i3 - Absorptior�are /L/. T�" Dwelling �� 7,t� PERMIT NO. _-✓,.- 6 5G �f 2— Manufacturers,�/j/1 '( •raj i° -� ��,f� i Material - -77/:::764- No. of compartments ,, / Liq. c.pacity i gallons /y/ .7- IF HOMEMADE: Inside length VVio til Liquid depth • a-' DISTANCE T0: Well Dwelling PERMIT NO. O m = 3: ' Manufacturer Material Liquid capacity in gallons E TILE DRAINFIELD TRENCH DISTANCE TO: Well . / %/ Foundation, - / - Nearest lot line/1 /! PERMIT NO. ,/ ro„> t7of✓•d No. of lines/ Length of ea�ci)ine .�.� Total length of fines J� Trench width j •_ •aasfaee Distance between lines N/l!i Top of tile to finish grade ; / LIQ Material beneath tile / -indtes• Total effectivbsorption area ,Z,5 C I'Q, ,e -r, Length Width Depth PERMIT NO. o. h w Type of crib Crib diameter Crib depth Total effective absorption area co DISTANCE TO: Well Building foundation Nearest lot line a J Class Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank r / Z�m Absorption area (sl /� / '® OTHER PIPE MATERIALS. b.Jk L SOIL TEST RATING /Z,S 5'0•t / iMn = INSTAL.LER•. ( REMARKS Vf&LS 1/ ('/ 0‹ /La a� �F _ 4- 01110 4-0/r'eia -1,1 a J ri r iii0 _ 77-.4) 13 k calf ,� „..-$5--- .,k_ non d"' 5?,:cloi-i- ,14:- IL,. ....-- fcR ar2:- /,tla' APPROVED DATE LEGAL _II ' > I / &KlcFy Pirkg 544. 7.10.,i R/F 'I/XI 72-013 (Rev. 3/78) PERMIT NO: DATE ISSUED: APPLICANT: ADDRESS: CONTACT PHONE: LEGAL DESCRIP: LOT SIZE: MAX BEDROOMS: �113 C2.:: :IC onb IL_ 1: lr OF" PA HA C3 FR eAl C3 FE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 025 L STREET, ANCHORAGE, AK 99501 264-4720 85O4O2 A7/09/85 STEVEN P. MATTER SRA BOX 8509 BIRD CREEK, AK 99540 653~7617 SUBDIVISION: PITZER SECTION: 9 TOWNSHIP: 10N 37420 (MFT" OR ACRES) 2 Listed below are the options available to system. Choose the option that best fits DEPTH TO PIPE BOTTOM (FT.) GRAVEL DEPTH (FT,) TOTAL DEPTH (FT,) GRAVEL WIDTH (FT.) GRAVEL LENGTH (FT,) GRAVEL VOLUME (CU"YOS.) TANK SIZE (GALS) SOIL RATING (SQ.FT./BR) LOT: 1 RANGE: 1W BLOCK: 0 you in designing your septic ybur site. ** TANK MUST HAVE AT LEAST TWOCOMPARTMENTS EV�].7)• 5"0 0"5 5.5 14"0 27"0 14°O 1,00A°0 125 ** � �� poi) 4"0 2"0 6"0 fJ.0 35"0 16^3 1,000,0 125 I certify that: 1" I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of Alaska" 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of, this permit" 3° I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot" 4° I understand that this permit is valid for a maximum of 2 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS -WILTS WILL NOT BE APPROVED' WITHOUT ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DON A LICENSED ELECTRICIAN. -~- SIGNED APPLICANT: STEVEN~�� MATTER ISSUED BY // DATE: z/e____~ DATE: MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 2644720 SOILS LOG — PERCOLATION TEST PERFORMED FOR: LEGAL DESCRIPTION: Z:07"1 .2I -OCT. P<7-.Xk�(' 5ili . SLOPE 6A1 od rxaY d,CM tlCi /ti/Xc'?b sit, ✓ s11'/�� cfziect WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? DATE PERFORMED: S L 0 P E SOILS LOG PERCOLATION TEST 710,(1 ?t' /!n) co SITE PLAN Reading Date Gross Time Net Time 1 ) Depth to Water S•9S Net Drop e..5 -» 40 ff - /61 /d /02- /c4,;40 /0 9<0 <5� a , 1f /r „.4.1/ :>,_,� //c /o 1 a,��o f ----- fit A/ ei--trf eta k Reading Date Gross Time Net Time 1 ) Depth to Water S•9S Net Drop e..5 -» 40 ff - /61 /d /02- /c4,;40 /0 9<0 <5� a , 1f /r „.4.1/ :>,_,� //c /o 5�7- a,��o 20 /7O/r, y•• �/ 'P 0 (minufeslinch) X 7 XI— TEST RUN BETWEEN/° / FT AND �FT COMMENTS,5/L,, F.i`4� } — %�Ti f(l, I-7 PERFORMED BY: / /i /=/t' 72-008 (6/79) PERCOLATION RATE CERTIFIED BY: DATE ➢REFI'. OF ENVIRONMENTAL CONSERVATION ANCHORAGE/WESTERN DISTRICT OFFICE 437 "E" STREET, SUITE 303 ANCHORAGE, ALASKA 99501 July 19, 1985 Alaska Environmental Control Services, Inc. 1200 W. 33rd Avenue, Suite B Anchorage, Alaska 99503 BILL SHEFFIELD, GOVERNOR SUBJECT: Waiver Horizontal Separation between Well and Septic Tank, Lot 1, Pitzer Subdivision, Bird Creek, Alaska (8621 -WA -026) Dear Sir: 274-2533 The Department has reviewed the subject waivrarc,reguest and hereby waives the horizontal separation between the Class "C" well and septic tank to 126 feet on the subject property for a single family residence only. Sincerely, Steven W. Eng, IYC1 District Engineer SWE/msm STATE OF ALASKA DEPARTMENT OF ENVIRONMENTAL CONSERVATION CONSTRUCTION AND OPERATION CERTIFICATE for PUBLIC WATER SYSTEMS A. APPROVAL TO CONSTRUCT //�, Plans for the construction or modification of ° ' �� c Si/�� l —/off (86. 2 F/ _ public water system located in a/ tat C..__/ � c /"C , Alaska, submitted in accordance with 18 AAC 80.100 by ❑ approved. (...v." � have been reviewed and are .E'1G LA../ conditionally%approved (see fts). 4 . F^/' (i aiwt-^c-t A / Ejrrry /'A e' e BY TITLE DATE If construction has not started within two years of the approval date, this certificate is void and new plans and specifications must be submitted for review and approval before construction. B. APPROVED CHANGE ORDERS Change (contract order no. or descriptive reference) Approved by Jl/ujvet' 1:07(/ u.r%a/ fc)7ere4/,a// A c'/I /2C Ff Date C. APPROVAL TO OPERATE The "APPROVAL TO OPERATE" section must be completed and signed by the Department before any water is made available to the public. The construction of the 7, ve water system was completed on granted interim approval to operate for 90 days following the completion date. public (date). The system is hereby BY TITLE DATE As -built plans submitted during the interim approval period, or an inspection by the Department, has confirmed the system was constructed according to the approved plans. The system is hereby granted final approval to operate. BY 180407 (Rev. 11183) 4 / TITLE DATE DISTRIBUTION: 1. WHITE - ENGINEER (Complete Section C) 2. YELLOW - WATER SYSTEM FILE (Complete Section C) 3. PINK - ENGINEER/MUNI-BOROUGH (Complete Section C) 4. GOLDENROD - MUNI -BOROUGH (Complete Section A) 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 HAA#_��GC. Parcel I.D. # V G1-eiz 6•-3- 1. GENERAL INFORMATION Complete legal description F111410 L QT I ITZ� (L Sc1 BD . Location (site address or directions) Property owner €D POW ELL_ Day phone ZZ 8—X55 1 Mailing address 52 gox �S °I S t 6120 c -✓1 EEr' A 9'9 G40 Lending agency SEATTLE-, Mo2T64Acia Day phone 3(.°7-"" Mailing address S(Q 'E 3`tr'14 Su r1 t , IO(Jcr-1-c12AC iz. Ar, 9 35b3 Dot, Mioti.1 Day phone Agent Dcc-K- Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 3 CLASS )C NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer x NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Roy. 1/91) Front MOA 921 Parcel I.D. # MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 9951.9•-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING HAA # PPI Q61 OQ2l5S 1. GENERAL INFORMATION Complete legal description LQT 1 PrTziE2 s( -1-3P. Location (site address or directions) Property owner S1 FVE MATTt=2 Mailing address 14 C .&oX 850'1 'Shea CK. 5EAT'tLEI Lending agency • mo27-6/46 Mailing address f°p E a1�tt SU -("M l06 Ac..c•O ,ort_ SO 3 Day phone 6753_1(0(7 Day phone SiP 2(4, Agent DI Gly 02- C,4T1iY Day phone Address Unless otherwise requested, HAA 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water will be held for pickup. 3 CL,4SS rG 1 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA d21 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 hl I4 sa U KAn( COPJSULrinI t £I XS Phone Z72-� I I I Address 2o3 I i 04 AnlcE}ore.A4E.., AK 9' SD I !!I G Engineer's signature Date "5/"2Z/'��' aQ C'7r`14r "Y, }ov0 �5or/ .�C-CyF9 CCv``'( ILLLI/�/ �x�� c� az-ed /-- - - 6. DHHS SIGNATURE CF.. 5' 7 4 % 1 of _ MM./4) Approved for bedrooms. '4A s` Disapproved.'`v Conditional approval for bedrooms, with the following stipulations: By: Additional Comments ' CAUTION 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 tt21 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 1416° 'f& - �o1\1 SU1.r06( 6-SPhone 27 2 — 7 11. ( Address 2-c• 11--)t S L $! I o +�b•L�C40(2-AGE( A ° O l Engineer's signature ft/r \ Date } • S^O,peao*.,,..if rp at 6. DHHS SIGNATURE damvito1.100 Approved for bedrooms. Disapproved. ) Conditional approval for /7r '. J / bedrooms, with the following stipulations: And %t',f /// 4. -fir ,1'.J /12__Z?e /7/' Tl /7' 14 t:./J7 r( /i !l, fav• Additional Comments Date ///:YJIM CAU1'I o N 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 (flov. 1/91) Back MOA 921 Legal Description: A. WELL DATA Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST LoT 1 Pirz-Ee Su,g Parcel I D d 9 d 0 21 S S r � Well type PLI& 1 G C If A, B, or©attach ADEC letter. ADEC water system number 2-1-7 5 42_ 2 Log present (Y/N) Date completed -24"� © Driller f'Enix1 ���SE Y Dk ILt-)/ Total depth I to I 0 Cased to 120' 4) Casing height 2 0 Y Y© Sanitary seal (Y/N) Wires properly protected (Y/N) Date of test Static water Well flow Pump level FROM WELL LOC 9-20-7e8- /Co 2 ►ID d level lad �S 2.qQ 106'0 SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot 2 I , Absorption field on lot Public sewer main Public sewer service line N Petroleum tank .C-1Alt,4Ete, jt4OicArep 1a01:4'E tn./ V�e(Nntl gpm 1 106) ' On adjacent lots 140'+ C) 't -c, E C C-Lo;EST ) N /A Public sewer manhole/cleanout N/A. AT INSPECTION �p, \L� NIA SF --E ACICcm �parfY Uf-i tr t icHORAGE: CATI Ac6'E€0 ENVIRONMENTAL SERVICES DIVISION 21 1992 RECEIVED ( ; On adjacent lots I Tb F (cLoSEsT) WATER SAMPLE RESULTS: PASS C rract4 o) Coliform CATTAC1 ) Nitrate PASS Other bacteria Date of sample: I- 8- 92 © Collected by G MA B. SEPTIC/HOL94NQ TANK DATA -10- 9'2 IC?o0 I Z d Date installed Tank size 9 a Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) a) High water alarm (Y/N) N /A Date of pumping 8 --OI2 Alarm tested (Y/N) N/4 �x I ST 7: J:. Pca mPtd CLI.I 54+co BACK -FI I -L£12 SEPARATION DISTANCES FROM SEPTIC/HOLDtN-O TANK TO: E Cc�oSr=sT) r Q t Well(s) on lot 121 On adjacent Iots217 *To saur►IwfsTFoundation 3' t'C� To property line IS Absorption field '40 Water main/service line N /A Surface water/drainage N/As Q MEA5L4 0/obs eviro Q,Y I4PcE. 1-92 72-026 (Rev. 3/91) Front MOA21 ( F2,0M 1'l LES CONTINUED ON BACK PAGE ASSumEQ yo €,F CASED tea FULL o PrN 't)ELI-LC E 0OMNI 'FA SAtO C.hJOEe l4ous,E Int c2AwLSPACe. I -IQ -q2. INSTALLED co @7RnIK TOFIgdS C. LIFT STATION Date installed D. N /A Manufacturer f Size in gallons Manhole/Access (Y/N) Vent (Y/N) "Pump on" level at •••••••••"Pump off" level at High water alarm levelCycles tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO:-.; Well on lot N /A On adjacent lots ABSORPTION FIELD DATA I-9-`12 Date installed Length GfP•S t© Width 2-o1 Total absorption area _112c5 5F Depression over field (Y/N) Surface water Soil rating •.16P(7 /SF System type MDLtnlD Gravel thickness 1 1 (.51erLow PlPO1-otal depth S BeL-oiv Ex+sr Cleanouts present (Y/N) Results (pass/fail) N/A Peroxide treatment (past 12 months) (Y/N) N /A Date of adequacy test for SEPARATION DISTANCE FROM ABSORPTION FIELD TO: (GLQSEST) Well on lot 10(o I (7 On adjacent lots RA' •1D Sly To building foundation(0691 (a-oscsr) On adjacent lots 156 T SIA�i E1 Cutbank Surface water NSA Curtain drain INN/A. N/A NEW SYSTEM If yes, give date bedrooms Property line 10.1'o To existing or abandoned system on lot N/A. IGG-? Water main/service line 14/A Driveway, parking/vehicle storage area E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signature Engineer's Name r-��. e: Date r 6?---u- Date HAA Fee $ /h U� Date of Payment / Dvareo Din Fi g cl~ ..: MINMEMMI Waiver Fee' $ / Date of Payment Receipt Number_ => J �` (./f l Receipt Number © MgASU1E01 o6SE.V►E/ BY kiecE 72-026 (Rev. 3/91) Back MOA 21 DEPT. OF ENVIRONMENTAL CONSERVATION ANCHORAGE DISTRICT OFFICE 800 EAST DIMOND BLVD., SUITE 3-470 ANCHORAGE, AK 99515 Carl Abrams High Phukan Consulting Engineers, Inc. 203 W. 15th Ave., Suite 104 Anchorage, AK 99501 January 17, 1992 PWSID #217542 WALTER J. NICKEL, GOVERNOR (907) 349-7755 My review of the records on file in this office reveals that the Lot 1 Pitzer Subdivision Class "C" Public Water System, is in compliance with the provisions of 18 AAC 80, State of Alaska Drinking Water Regulations. Sincerely, Keven K. Kleweno Lead Engineer KKK/cf IVI-W DRILLING INC. P.O. BOX 110378 ANCHORAGE, ALASKA 99511 PHONE 349.8535 NAM Er,� AD�FiE55 ).7))0y. 573 GITYi Liovr) 14. 975?? LEGAL DESC IP ON - S-iEvG iA,,j% sYL\J Y- f"IN. i rE[Z J T 1 Pi -[?6l? ��C�S. life CREEK LEGAL OWNER AK. cicrSL �/ l) J l D SANK OR LENDING INSTITUTIONS CURRENTLY HOLDING DEED OF TRUST HOME PHONE 'WELL NUMBER AV/ /1° PUMP MANE HP deer oTe, MODEL WORN PHONE DIAMETER CI f/ DEPTH ao IiuVOiC(Li i l ' 41 3 9 4 (J DATE /', -- /C CITY. M AT E FjJ AL5 • ' (//h b' 'UNIT PRICE LC S C AMOUNT Sly 3? L / '' f_v. <. /.7r STATIC LEVEL TOTAL MATERIALS 60 / {7 A GPM DRAWDOWN SERIAL NUMBER 0 // p L f1- gg -• - DESCRIPTION OF WORK SETTING VOLTS 3o• PF ASE AMP RATE SCREEN LENGTH SLOT SIZE I LINER/SCREEN DATES iJ _F- _E,c_tiF_irio fieom vIv_iiiik_r_v_.(cf—cl" A// charges shatl be paid in lull within ton days .unless other arrangements are made prior to drilling,The customer shall pay Irl L serest at the rate o/ 1 %, °h per month on any amount not paid within ten days. Failure to pay may result in a lien against the property WORKMAN DATE IN OUT LABOR HOURS y� l� RATE O� % S 0G - / �F ��N / /�' C /s� ✓ MATERIALS IFROM AROVEI a'( !/! OTHER CHARGE, CUSTOMER SIGNATURE PAY THIS AMOUNT ..._,„. r 7 �i 8 0 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. TELEPHONE (9O7) 562-2343 Drinking Water Analysif TO BE COMPLETED 13Y WATER SUPPLIER PUBLIC WATER SYSTEM I.D.0 PRIVWAS F • M Name I 7 Pnone No. 5633 13 Street Anchorage, Alaska 99516 for Total Coliform Bacteria Mailing Addross Clly SAMPLE DATE' SAMPLE TYPE: cl :talo Ell Mo. Day Your Zlp Codo Routine Check Sample (for routine sample with lab ref. no. ) 0 Treated Water Speciallrpose 0 Untreated Water Ars SA LE ® Collor NO. LOCATION Collected Hy N,.„ ea riZod4r 00(1-I I2: I'S C444 I LAT t trzcii - 1.=a 2 1 —_ 1 3 L____ _J 41 5 1 —1 TO BE COMPLETED BY LABORATORY Analysis shows this Water SAMPLE to be: r Satisfactory ❑ Unsatisfactory ❑ Sample too long in transit; sample should not bo over 30 hours old at examination to Indicate reliable results. Please send new sample via special delivery mall. Data Received Time Received — Analytical Method: Membrane Filter " No. of colonies/100 ml. Lab Ref. No. 92.0090 ..? Result" Analyst C'-ta r 10 LE I FE L_ 1 LEI .__.___ _.,tee A.D.-E.C. -272.z CNV READ INSTRUCTIONS BEFORE COLLECTING SAMPLE TNTC = Too Numerou 013 = Other Bacteria BACTERIOLOGICAL WATER ANALYSIS RECORD Membrane Filter: Direct Count Verification: LTH Final MembraneFllt Flit Reported By L 0013 CollIormt100 ml Colllorml100 ml PART ONE OF TWO: REMAINDER TO FOLLOW Date C Time: . a rn p.m. u CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 1Li. lo 5633 b STREET ANCHORAGE, ALASKA 99510 TELEPHONE (907) 562.2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE 9 50172 Chomlab Ref .1 92 0098 Samp).e 9 I Nat rix: NATER Client Sample ID BATUROON SINK BY FRONT GOON PWSID : UA Collected : JAN 8 92 0 12:40 hrs. Received : JAN 8 92 8 12:50 hrs. Preserved with AS REQUIRED Analysis Completed : JAN 10 92 Laboratory Supervisor : STEPHEN C. EDE Releoeed By V'fY•l/5 ( l Client Name :HIGH ?HUNAN CONS EHCR Client Acct :1iIGHPHU BPOI : P01 :NONE RECEIVED Rog, : Ordered By : Send Roports to: 1)IIIGH PINEAN CORS ENGR 2) Parameter Reeultu Unite H•thod Alloweblo Limits H1TRATE-N 0.51 mg/l EPA 353.2 10 Sample ROUTINE SANPLE COLLECTED BT: C.H.A., WITNESSED BY STEVE NATTER hematite: • 1 Tests Performed ND- None Detected Me Not Analyzed ' Sex Special Instructions Above " 3ee Sample Romarku Above LT -Less Than, CT -Creator Than UAeUnsvailable Monlbor of the SGS Group (SocI61d GOn9rnlo cls Survoillnnco) 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 1. GENERAL INFORMATION Legal Description (include lot, block, subdivision, section, township, range) (r ((n� / el-ze , 7~7(9(1/r eini( Location, (address or'di"ections) ( ��. Telephone: Home may_ L7 Business Applicant Address 1)::L, -111.8_0A" 5550 G a 5-510 (c) A ap1,cant is (check'ohe): Lendiigg Institution 0 ; Owner/builder-faz; Buyer 0 ; Other 0 (explain); _ P: (a) Application Date L 27-g..5 (b) Applicant Name•6_1-er � `titi. ?G • Telephone as y �, (d) Lendl � 11sti4if-, 1 ,. Address re""' (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESfDENCE MUNICIPALITY OF ANCHORAGE TILA Single -Family PK Multi -Family) Other DEPT.OFLHPROTECTION PROTECTION Number of Bedrooms 3. WATER SUPPLY Individual Well 0 Community3 "Puhlic Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. OEC 3 01985 RECEIVED 4. SEWAGE ISPOSAL Onsite Public 0 Community 0 Holding Tank 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (11/84) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA 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 verity 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 Address p Telephone 60/- (9 2 Date (� " 7_c; `5 6. DHEP APPROVAL, 6,2 Approved for /0.26,1_ 'bedrooms by Approved -- Disapproved Terms of Conditional Approval (00 074Cie?.. "11' `tO vino.tot`� I a1� ®� : oma as�1 °�S�° ate / Conditional 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) A. WELL DATA Well Classificati i n Well Log Presen 'WCased to eolVizair MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description 407— / e/'xK j1 %r 7 -7 77o,1 g�U/ f& -e_ Total Depth Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot ® /Z!a If A, B Date Completed D.E.C. Approved ® ) Yield // Depth of Grouting Pump Set At /041 Sanitary Seal on Casing (Y/N) 4/7) Depression Around Wellhead (Y/N) To Nearest Edge of Absorption Field on Lot /(/// To Nearest Public Sewer Line Cleanout/Manhole �n1 / Water Sample Collected by /rdte} � f,/j ,4? etite Water Sample Test Results /ll�"t �ms'"'� Comments (2) Fe C✓It7✓ 'i /17060 /57/ ; On Adjoining Lots ; On Adjoining Lots To Nearest Public Sewer /(/l] /14 �1Lo A,(oes_ To Nearest Sewer Service Line o ; Date B. SEPTIC/HOLDING TANK DATA Date Installed Standpipes 075' Size /40 1 6'- No. of Compartments Depression over Tank (Y Air -tight Caps N) Pumping/Maintenance Contract on File (Y/N) Holding Tank High -Water Alarm (Y/N) WA - Separation Distances from Septic/Holding Tank: To Water Supply Well / / dIA Foundation Cleanout (Y Date Last Pumped ;for ii//1 Temporary Holding Tank Permit (Y/N) To Building Foundation To Property Line /0 To Disposal Field To Water Main/Service Line /`%�/f To Stream, Pond, Lake, or Major Drainage Course 0 Comments y11/ MtiNICIPALI l Y OF ANCH';3RAGP DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION Pageiof2 72-026(11/84) DEC 3.0 1985 RECEIVED C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata %LSA Date Installed Width of Field 5-i Square Feet of Absorption Area Depression over Field (Y Results of Last Adequacy Test If Type of System Design r .55r Length of Field Depth of Field Gravel Bed Thickness yS—p Standpipes Presen Date of Last Adequacy Test .04 Separation Distance from Absorption Field: To Water -Supply Well /5-( ' JS To Building Foundation Lot To Water Main/Service Line To Property Line ; On Adjoining Lots To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Existing or Abandoned System on To Cutbank (if present) Se2/7- D. LIFT STATION Date Installe Dimensions Size in Gallons �� Manhole/Access (Y/N) "Pump Off" Level at "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Vent (Y/N) ing Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company tar,— Date f - 2 7 CrC MOA No0-;� Receipt No.312-- I Date of Payment -2, d KC Amount. $ WS 1 y) Page 2 of 2 72-026 (11/84)