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POLLOCK HOMESTEAD BLK A LT 1
Pok k C� Cr2 S.C.. LLN� miab''= J,C)k%)-oawLkz MUNICIPALITY OF ANCHORAGE DFPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 87.5 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT -- - e PHONE D NEW NAME {f&mt,r i�icp/ ne l H j f�J�•% ® UPGRADE MAILING ADDRESS zol Po//67.lr Dr=lwe' Ancttorcuye Air- 9-7.5`(6. _la LEGAL DESCRIPTION �CC L.o f l 81k A Po ll c.°c 1c 1�timlo:S� ) NO. OF BEDROOMS LOCATION� l-s'e 3 Well Absorption area Dwelling PERMITNO.NO.. Q DISTANCE TO: l'Z >a I�r�, Materi I nufacturer TF No, of compartments /^��er� (�" rn Inside length Width capacity in gallons IF HOMEMADE: Liquid depth & Well r Dwelling /'� DISTANCE TO: V216 2to PERMIT NO. -03/'SMate ialLiquid anufacturer {-top,f`Z0 capacity in gallons BeiWepFoundation Nearest lot line PERMIT NO,DISTANCE IF TO:o. of lines Length of each line Total length of lines Trench widthDistance inches between utes Material beneath theTotal op of the to finish grade inches effective absorption area PERMIT NO. LengthDepth °'a Type of crib Crib diameter Crib depth Tal effective absorption area Lu Well Building foundation Nearest lot line N DISTANCE TO: Depth Driller Distance to lot line PERMIT NO. J Class J w Building foundation Sewer line Septic tank Absorption area s DISTANCE TO: OTHER PIPE MATERIALS SOI L TEST RATING N,11, t ti. / �crs' n 5't e to INSTALLER _ �Jwner' REMARKS laz�I�Inf 1�"ccnk 5el- in S�r+Kl • 3 1' �' l � .s Y F' 11 dee atr fu e bcctr_ l Ct_ dI &I ve,` enA're _ SQ �1- AR4V t7. t71,d f/ y �-i`n /t . �7F�i. s 1 ••.��® Uq •Y� 78 2 'G l lal !h<_ 11 C X 0 0 9 1•• 4 1 Y O e• ••. I Y • Y' 1' " W V 'Yf' alarm Ins per pQrrn! t...... .......... w �� v ° Y CL Pffl MuI��J/ I`�� t%n Vf1 J •�[�• V��(�Prt/a °YeYerr'•.^SIC 4y _ APPROV EG. D` ATE LEGAL nrfJ11 ,5 t'1 aLLSG_ 72-013 (Rev. 3/78) yl&W J 1 yr,D r n,rrne/tr C'a'r ����������������� .~ DEPARTMENT O HEALTH � AND ENVIRONMENTAL ` �TECTION ' 825 � STREET, ANCHnRAGE, 8K 99�r1 ` [ 264-4720 _ IE---. PERMIT NO: 850315 HOLDING TANK DATE ISSUED: 06/18/85 APPLICANT: HOMER D" BARNETT ADDRESS: 15201 POLLOCK DRIVE ANCHORAQE, AK 99516 CONTACT PHONE: 276--5055 LEGAL DESCRIP: SUBDIVISION: POLLOCK HOMESTEAD LOT : 1 BLOCK: H SECTION: 34 TOWNSHIP: 121\1 FAI\GE: 2W LOT SIZE: 22470 (SQ"FT" OR ACRES) I certi�y that: 1" I am familiar, with he requirements for on~site sewers aDd wells ag s�t forth by the Municipality of Anc-lprage (MOA) ancj 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 adhcPe to �.all MOA and State of Alaska requiremeDts for the set back distances from any existing well, wastewater dispovi@l system or public 5�ewerage System an this or anyadjaceOt or nearby lot." IF A LIFT STATION IS INSTALA-ED IN AN AREA COVERED BY PIO# EDILDING CODES, THEN (1) ON ELECTRICAL PERMIT OND I.NSP�CTI8N MUST BL;.* (2) WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTJON REPORT; AND (3) TME ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNUED L) m, �� �������..... ..... .... ��..... �� 8PPLICANT: HOMER D BARNETT ISSUE DHTE: (53 � � ®� MUNICIPALITY OR ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION P 825 L Street - Anchorage, Alaska 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT NAME: - PHONE] NEW iH`j-''�"yl`.i/ ❑ UPGRADE l3 `r"») f•w-L—fU (=:�.1[}L_��1_�7Z=%— L��LV �_� --- •. L �J MAILING ADDRESS p) tc) Aux i+ A- K— QCl 1 t I LEGAL DESCRIPTION ��T 1moo(-�: A �� �J�a s lee��l _ �S'��4. LOCATION 1 e NO. OF BEDROOMS Well Absorption area Dwelling PERMIT NO. U DISTANCE TO: JII W % } 0 l U l 1,?oz, c1 (!9 Y r Z LU Manufacturer Material .`_ e is No. of compartments to Liq. rapacity in gallons IF HOMEMADE: Inside length Width Liquid depth ® 8 Y DISTANCE T0: Well Dwelling PERMIT NO. = z b Manufacturer Material Liquid capacity in gallons 8 wx DISTANCE TO: Well �(� 'i' Foundation �Q l Nearest lot line �S '1' PERMIT NO. Z� e, e? W az No. of lines Length of each line Total length of lines Tronch width Distance between lines 7 h z w 6 — Lu C) inches J QccTop — of the to finish grade Material beneath tile Total effective aabsorztion area O Z cr —_C'1— inches 3A 6 ff , .e. Length Width Depth PERMIT NO. UI' Q f^ Type of crib Crib diameter Crib depth Total effective absorption area Lu Y. -- w N Well Building foundation Nearest lot line DISTANCE TO: Class Driller Distance to lot line PERMIT NO. � w � undation EBd _ Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS SOIL -TEST RATING II — INSTALLER — AN' -- REMARKS - --- - -- J. 3 i �� — �r '49TH She seeeeaeeee. e. ee ee e�ea� [;� a fe• e•>eee'.e� e — `� -�` � • V� 5n'is LEGAL APPROVED DATE p R 72-013 (Rev. 3/78) 01������� DEPHRTMENT 'HEHLTH HND EN;IRONMENTHL (OTECTION 82� 'L� STREET, HNCHORHGE, IS, 99501 264~4720 Q! I Jl:� P. PE-.:: !sv W R K 141 F41 to, FIE to! Wq :11 F PERMIT NO ( 8202D8 ) \(' - HPPLICHNT HOMER D BHRNETT 21-]618 CITRUS ELMENDORF HFB~gir 73]-7294 L0CHTION LEGRL L1BLOCK H POLLOCK LOT SIZE ~ 22470 SOUHRE FEET TYPE OF SOIL HBSORPTION SYSTEM IS� TRENCH MAXIMUM NUMBER OF (SQ FT/BRY, ]]0 THE REQUIRED SIM OF THE SOIL HGMRPTION SYSTEM IS: now �is: N oil -W- 1-1 Sm 15, Ron ;�? M Ayr FIE 1— �K W -1, 1-1� � THE LENGTH DIMEHSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHIOFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTHNCE BETWEEN THE SURFHCE OP THF�: GROUND HND THE BOTTOM OF THE EXCHVHTION (IH FEET) THERE IS NO SET WIDTH FOR MENCHES. THE GRHVEL DEPTH IS THE MINIMUM DEPTH OF GRHVEL BETWEEN THE OUTFHLL PIPE HND THE BOTTOM OF THE EXC8VHTI()N (IN FF: ET). M ohn 141 A- I X too FIE R0 15 to" -F" X KV K 101 r;El fc:�-,Y K::-.: i i 5* 111! 1����� PERMIT RPPLICHNT HHS THE RESPONSIBILITY TO INFORM THIS DEPHRTMENT DURING THE IHSTHLLHTION INSPECTIONS OF HNY WELLS HDJHCENT TO THIS PROPERTY HND THE MUMBER OF RESIDENCES THHT THE HELL. WILL SERVE ������ BHCKFILLING CIF RNY SYSTEM WmHOUT FINHL. I14SVPECTIO04 HND HPPROVHL GY THIS DEPHRTMENT NILL BE SUBJECT TO PROSECUTION MINIMUM DISTHNCE BETWEEN H WELL AND HNV HL SYSTEM IS 100 FEET FOR H PT'!IVHTE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL MINIMUM DISTHHCS: I'MOM H PRI4"8TE NELL TO H PRIVHTE SENER LINE IS 25 FEET HND TO 8 COMMUNITY SENER LINE IS 75 FEET. WELL LOGS HRE REQUIRED HND MUST BE RETURNED TO THE DEPRRTMENT NITHIN ]0 DHYS OF THE OTHER REQUIREMENTS MHY 8PPLY� SPECIFICHTION5 HND CONSTRUCTION DIHGRHMS ME HVHILHBLE TO INSURE PROPER INSTHLLHTION ��fl -11 EEC �NET RVII 19 IsE vw,�, . .. ... I CEFITIFY TINT J. I HM FHMILIFR NITH THE REQUMEMEOITS FOR ON~SITT'. SEHERS HND NELLS HS SET FORTH BY THE MUNICIP8LITY OF HNCHOR�GE 2� I WILL INSTHLL THE SY�TEM IN HC�ORDHNCE WITH THE CODES ]� I UNDERSTRND THHT THE ON&SITE SBkIER SYSTEM MHY REQUIRE ENLHRGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THHN ] BEDROOMS!t'D~\,, '���� >��^ / SIGNE ^`� "^~�'�~~-~-�~�-�~-.... HPPLICHNT HOMER D BHRNETT ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE 0 +.e` DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG — PERCOLATION TEST PERFORMED FOR:1�112 DATE PERFORMED:�f LEGAL DESCRIPTION:�,�� �/ �GI��C/"J r'(i��� .�(�. �� cjiy/ / 5%(2�'j DEPTH SLOPE SITE PLAN 1 3 4 - 5 6 7 c7 ' -0 8 10 �1`erc/G It r7/ 11 - WAS GROUND WATER S — t ENCOUNTERED? _ S L O 12 n.• P — o IF YES, AT WHAT E f) DEPTH? ,....... ..... 13 = 14 15 ME 17 DRIP �+•c••sa••r°••sas°•ewi•• B a ° • 4) •A°C•H°••H••a°u �•°°•M• pe• 18 Q Oarnh O. Talbot w I �A 19 ® �iCo ADB. °•00 20 COMMENTS Reading Date Gross Time Net Time Depth to Water Net Drop it t/A "�?•''�0 i�� 0 s PERCOLATION RATE_ > t/% °(minutes/inch) TEST RUN BETWEEN � /}e FT AND FT PERFORMED BY: Gf-I 1, 1� l ,r� c� %{may 7_CERTIFIED BY: 72-008 (6/79) T INT SOILS LOG MUNICIPALITY OF ANCHORIMICP°IIT' OF ANCHORAGE �.\ DL -'1. OF i-_r/AlL, 3: PERCOLATION Ap DEPARTMENTOF HEALTH AND ENVIRONMEN ,,P-kPrAQTI,Qd,;C iC,( TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 \--� SOILS LOG — PERCOLATION TESTMAf3 5 ' "p''l -'-:p`M D -/ -) h, PERFORMED FOR: I I /riJiDAEJFORD' LEGAL DESCRIPTION:/ J-3/OC=� 6T 90//04 SF�clr1 . .P II SLOPE SITE PI Ab 0A Nrs,s f �dd„G I 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 7-11201/,, # COMMENTS PERFORMED BY: 72-008 (6/79) WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? ,t r� Rk6Cj-'V-E lead. Reading NNINNEENNI Gross Time Net Time Depth to Water -f Net Drop.r*. If f n ,t r� Rk6Cj-'V-E lead. Reading Date Gross Time Net Time Depth to Water -f Net Drop.r*. If f n PERCOLATION RATE tJ d✓' (minutes/inch) _' , s_ SA - TEST RUN BETWEEN gl J' FT AND ��s. FT 5 AllLWo L-4 CERTIFIED BY: r , DATE: ✓'— Il �5'l iclo pa Alit of Anchorage July 29, 1981 825 "L." S1 REET ANCHORAGE, ALASKA 99501 (907) 264-4111 GEORGE M. SULLIVAN, MAYOR DEPARTMENT OF HEM,] ANO FNVIHONf,.91 N T AL PROTECIfION Brian IIawkins James Smith Transa-laska Realty, Inc. 1577 C Street, Suite 103 Anchorage, Alaska 99501 Subject: Lotl Block A Pollock Subdivision The percolation test submitted to this department indicates the soils are acceptable for on --site sewer.. The percolation rate was 60 minutes/inch. This indicates the soil is at its upper limits for absorption. The dimensions would be: total depth 9 feet, total length 120 feet, with 5 feet screened gravel backfill. If there are any further questions, please call this office at 264-4720. Sincerely, Robert C. Pratt, R.S. Associate Specialist RCP/ljw WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological a Geophysical Surveys Drilling Permit No. <:n ,�L LOCATION OF WELL (Please complete either to, Ib or Ic.) A.D.L. No. I� Borough Subdivision Lot Block Ib. 1/4 glrs. Section No. Township Range Meridian ofvof �oi� S O 0 —_ Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS 3. OWNER OF WELL: _ 1-i• Address /1 Street Address and Area of Well Location � f r 2. WELL LOG Feet Below Surface 4. WELL DEPTH: (final) 5. DATE OFCOMPLETION Material Type Top Bottom ft. �-� --�---+%-• 6, D -Cable tool ❑ Rotary Driven ❑ Dug Auger (:]Jotted ❑ Bored D Other: 7. USE: E]DomesticE] Public Supply Industry DIrrigation Recharge Commerical Test Well Other: — 8, CASING: D Threaded Q Welded ^— dlam.- In. to ft. Depth Weight Ibs./ft. diam. In. to__ ft. Depth Stickup a it. 9. FINISH OF WELL.: Type:;__ - Diameter:-- lometer:-Slot/Mash Slot/MashSize: Length:___ RAGE Set between _ ft. and ft. Backfilling _ _ _ Grovel pack PT. O` 1" 1.T:1 10, STATIC WATER LEVEL: r ft. Above or D'Below land surface Irate ,iEJ Equipment usedKt�: - _ r _.-. - II. PUMPING LEVEL below land surface and YIELD ft. otter hrs. pumping g,p, M. -ft. after hrs. pumping_ g.p.m. v 12.GROUTING Well Grouted: Yes Q'No Material: D Neat Cement EJ Other: 13, PUMP: (If available) HP Length of Drop Pipe ft. capacity g.p.m. (, 'Subm. D Jet Centrifical D Other 14. REMARKS: 16. WATER WELL CONTRACTORS CERTIFICATION: --'— ""--'— ------ ----- - `D 15. Water Temperature ^°`D F C This well was drilled under my jurisdiction and this report is [rue to the best of my knowledge and belief; Registered Business Name, Contract License Number Address: Signed : , �_� -:.< ,-n.,.. _- - Authorized Re pre sentdtive Form 02-WWR (11/81) Copy Distribution: WHITE-Stote DGGS, PINK-Drillor, CANARY -Customer V Municipality of Anchorage On -Site Water & Wastewater Program (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL Parcel 1. D. 017-112-48 Expiration Date: /S 1. GENERAL INFORMATION Complete legal description POLLOCK HOMESTEAD; BLOCK A LOT 1 Location (site address) Current Property owner(s) Mailing address Real Estate Agent 15201 POLLOCK DRIVE ANCHORAGE, AK RAY DAHL Day phone 244-7611 RAY DAHL Day phone 244-7611 2. TYPE OF DWELLING: Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Individual On-site ❑ Individual Water Storage ❑ Individual Holding tank Q Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Received by: COSA to be released to t!fn er, unless ahv, a requested by the engineer, COLA d COSA Fee $ 5" Date of Payment /;'-/ -JOIE Receipt Number 691 6- COSA # - COSA# 05C-II[l�b� Distance: — Date: Waiver Fee $ ?61 //^ L / Date of Payment Receipt Number i5%Yi0�— Waiver # (% i2! C/ /5:5�2 5. STATEMENT OF INSPECTION BY ENGINEER 6. By, As certified by my seal affixed hereto and as of the validation date shown below, 1 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. 1 further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, LtD. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soils condition, groundwater levels that may fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, LTD. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole benefit of the owner listed above. Any reliance upon or use of this report by any other person or party is not authorized, nor will it confer any legal right whatsoever. DSD SIGNATURE System #1 Approved for 1Z bedrooms. System #2 Approved for bedrooms. Disapproved. r) Conditional approval for �2 bedro L=icotl �,w� shall j Fa V- f' Al Phone 337-6179 Date 000bOoppO OF 0'4 T X00 �.....�... . . S f'. A. Gam ess.• G Q 9� CE -795 Pl nFa��ion°� o J� pN-SITE G� r WATER AND �l o WASTEWATER Z wing stipular r : OGRAM .� T S%9 , ),�! ffc Original Certificate Date: 1 I �r Tpe1V unicipality or Anchorage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only Upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTCHMENTS: COSA Checklist 'f Nitrate Advisory Septic System Advisory / Arsenic Advisory Well Flow Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: POLLOCK HOMESTEAD; BLOCK A, LOT 1 Parcel ID: 017-112-48 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 10/1982 Sanitary seal (YIN) YES Wires properly protected (YIN) YES Total depth 73 ft. Cased to 46 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 10/1982 9/4/2014 Static water level 8 ft, 12 ft. Well production 1 9-p m. 0.4 — 9 -p.m -WATER SAMPLE RESULTS: 0,115 Coliform Aer� colonies/100 ml. Nitrate mg./L. Collected by: GEG. Ltd Arsenic: ND ug./L. Date of sample: (7-1Z7-/1 B. SEPTIC/HOLDING TANK DATA HOLD NG/SE EL 6/24/85 Tank Type/Material HOLDING/STEEL Date installed 9/25/82 2000 1 Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) NO Foundation cleanout (YIN) YES Depression over tank (YIN) NO High water alarm (YIN) YES Date of pumping 11/11/2014 Pumper A+ HOME SERVICES C. ABSORPTION FIELD DATA Date installed Soil rating (g.p.d./ft2or ft2/bdrm) _ System type _ Length ft. Width ft. Gravel below Total depth ft. Eff. absorption area ft Monitoring tube Depres Date of adequacy test Results (P I Fluid depth in absorption field before to _ in. Water added _gal. Elapsed Time: Final fluid depth _ in. Absorption rate >=_ ion over field— For—bedrooms ieldForbedrooms New depth _in. g.p.d. treatment (past 12 mo.) (YIN & type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Acoess (Y/N "Pump on" level at in. "Pump off' level at�i High water alar level at Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot N/A On adjacent lot; Absorption field on lot-- N/A On adjacent lots Public sewer main Sewer /septic service line 25'+ Public sewer manhole/cleanout N/A Holding tank Animal containment areas 50'+ Manure/animal excrete storage areas _ 100'+ SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field N/A Water main N/A Water service line 10'+ Surface water *25 + Wells on adjacent lots 75'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Water service line Curtail F. COMMENTS Building foundation Water Surface water on adjacent lots STEEL HOLDING TANKS ARE REACHING THE END OF THEIR USEFUL LIFE *SEE ATTACHED PHOTOGRAPHS OF BERM & WAIVER REQUEST 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 affect on this date. Engineer's Printed Name JEFFREY A. GARNESS Date I2/?O/ (Rev. 11/05) storage 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.ci.anchorage.ak.us (907)343-7904 Water Well Advisory p66 B4i asp `oo Certificate of On -Site Systems Approval (COSA) # OSC141668 During a recent COSA on-site inspection and test of the potable water supply well on Block A, Lot 1 of Pollock Homestead subdivision, the well's productivity was determined to be 0.4 gallons per minute. The minimum well productivity required by this Department (AMC 15.55) for a 3 -bedroom residence is 0.33 gallons per minute. Although the subject well currently exceeds this minimum requirement, all parties concerned are advised that the production capacity of the well may fluctuate. Restriction of non-critical water uses such as washing cars and watering lawns and gardens may be required. This advisory must be attached to all copies of the subject Certificate of On - Site Systems Approval. Lot 5 8408F 0 o LOT 1_ Lot 6 Shed ri I r f a t uj 4 30.4 A \rI �^ C I to d L6 ASptmalt. h i 0 a I ti O� : ^•tis ^ m L _ 7.. LL I t71 } LOO I 3Q.?3 D.. co 24.0 0 I i- 0 v 10.4 x O a O y P °0 O N 34.3 �' i o Z z 30 24.0 cO 2.3 O HXJ2' Storm Drain Mane, SCALE: V= 30' I 2` -storm Drain ----O PVC Pipe I rWeB I 25 N86°41'21"E 139.23 vm Lh 0 I RABBIT CREEK ROAD _ AS -BUILT NO CORNERS SET THIS DATE OF I hereby certify that I have performed a Mortgagee's Inspection ��4•- ('� of the following descrkmetl.property:. LOT t. BLOCK A POLLOCK HOM ST ADgt BOtVi IflP Anchorage Recording Precinct, Alaska. and that the• . . .... / ' 3rprovererda Situated thereon ... _ / and do not overlap or encroach ..... � W . �. , .... . , . �, � adjacent thereto, that no irprovemerKson thepropetit+ lying adjacent thereto encroach on the prey see in question and that there are no roadways, transmission lines or other visible easements on said Property except as indicated hereon. Dated at Anchorage, Alaska this 31st day of December ,2o14. FRED WALATKA & ASSOCIATES {907-248-1668} Engineers and Surveyors y n '• ar . 3255 - S • sEoru.4 F.ASEMENT$.OF RECORD, OTHER: THAN THOSE SHOWN ON THE RECORDED { c PLAT ARE NOT SHOWN HEREON {7 Lan#eeh BE GARNESS ENGINEERING GROUP Ltd "°` %' �� �t 8 Je CIVIL & ENVIRONMENTAL ENGINEERS .,ea.: ::.::.„m,;,.. �.-z -- L affi December 24, 2014 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 Elmore Road Anchorage, AK 99507 Ref: Pollock Homestead; Block A, Lot 1 To whom it may concern: We are request that your department issue a 25 -foot waiver from the existing holding tank to surface water. The existing tank is approximately 30 feet from surface water. The slope runs generally from east to west. A berm was constructed to divert potential overflow so that it would have to travel a path of greater than 100 feet to reach the surface water. We are unaware of any adverse impacts this waiver would have on adjacent wells or septic systems. S. 3701 East Tudor Road, Suite 101 * Anchorage, Alaska 99507-1259 Phone: (907) 337-6179 * Fax: (907) 338-3246 * Website: www.garnessengineering.00m Municipality of Anchorage P.O. Box 196650 a 4700 Elmore Road Anchorage, Alaska 99519-6650 • (907) 343-7904 • Fax (907) 343-7997 Department http://www.muni.org/Onsite Development Services Division On -Site Water and Wastewater Program **** VARIANCE/WAIVER REVIEW **** Waiver#: OSP141536 COSA#:OSC141668 Permit#: PID#: 017-112-48 Legal Description: Pollock Homestead, Block A. Lot 1 Engineer: Garness Engineering Group Applicant: Ray Dahl Your request for a waiver of the required 100 feet horizontal separation from the absorption field to the surface water has been approved. The approved separation distance is 25.0 feet. This waiver approval applies to the existing absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this waiver. ❑ Notarized letter(s) of non -objection have been received from the owners) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. ................................................•.............................1 Waiver is Granted: X Waiver is not Granted: Date: S Approved Name.of Revier ...........................................V .........ew..................... L■ ■ AAROW PUMP & WER SERvicE, LLC P.O. Box 110496 Anchorage, AK 99511 Office: (907) 346-9355 - Fax (907) 345-0202 Eagle River: (907) 622-9335 JOB SITE P.1 No. 10241 Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. IffO[) °�CgTE I WF_LL DEPTH Sv1L CHLORINATED PUMP DEPTH SAIFSPEFSON .. UAN ITY i — DESCRIPTION _ ------------ if o PRICE AMOUNT LABOR HOURS RATE AMOUNT TOTAL MATERIAL TOTAL LABOR WORK ORDERED BY TOTAL LABOR PAY THIS AMOUNT Thank You SIGNATURE (I Hereby Acknowledge the Satisfactory Completion of the Above Described Work and agree that if above work is not paid for in 90 days I agree to allow Aarow Pump & Well Service, L.L.C. the right to remove unpaid for equipment and charge for labor already performed & labor to remove unpaid for equipment) TERMS: ACCOUNTS PAYABLE AT 10TH OF MONTH FOLLOWING PURCHASE. SERVICE CHARGE AT RATE OF 1.5% PER MONTH WILL BE CHARGED ON OVERDUE ACCOUNTS. Parcel I.D. # MUNICIPALITY OF ANCHORAGE �1� • 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 G/7- // --, --q �/ HAA# AJA-s-90 z * 4 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions)7� x pry 1!5-2-01 FOLI-or- K pP)VcE A AmcGH K //SV6 f' (b) Property owner J4 (. n Telephone : (home) _ Business Mailing Address (c) Lending Institution Telephone Mailing Address (d) Real Estate Company and Agent ASS'0-iA7-En PC- eE,CS /<�A�4D% / Address �4C ltj 36 f)` #/ AKIr_14--A L �19�;-05 _ Telephone -D F> � - (e) Mail the HAA to the following address: (or check hereX,if hold for pick up.) List contact person and day phone number below: 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 community 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 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 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 r7pt If &L Telephone Address /dbG F 41205- AN -,14 Date Engineer's Seal 6. DHHS APPROVAL Approved for bedrooms by �`c� Date ��Z ApprovedDisapprovedConditional Terms of Conditional Approval CAUTION, The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated 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. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA)�� .. ANc((ORAlftalth Authority Approval (HAA) MUNIC- FEBRUARY 1984 �NviRONM ERVICES oivFii6CKLIST 343-4744 Il i1- 2 Legal Description: _LOT !SL f= A �y \I 13044 e- oL K S /Z !) A. WELL DATA 1�. c " r Well Classification _ Pg.I V,4 TE If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) _y__ Date CompletedIO2. Yield l.,y G p Iq Total Depth- -Z-:S- Cased to46'+ Depth of Grouting __UN CNOCdi.I Static Water Level _ /Z I Pump Set At i Casing Height Above Ground j Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) y Depression Around Wellhead (Y/N) �Sl _ SEPARATION DISTANCES FROM WELL To Septic olding ank on Lot IZ 6-, ; On Adjoining Lots �>Ino ' _ To Nearest Edge of Absorption Field on Lot !\ JA -k-,?C; On Adjoining Lots /00 To Nearest Public Sewer Line V4 To Nearest Public Sewer Cleanout/Manhole To Nearest Sewer Service Line on Lot Water Sample Collected by K Lr !le%,ct LQ _ ; Date Water Sample Test Results Comments #4Lo7- N,qS l )( DtAJ( 7-f?-lV K B. SEPTIC/HOLDI TSepfi� �zANK —DATA--� a Sed frc 7a„ r- — � Comte �-,,,.•„,f�' Date Installed M-5 ggize No. pf Compartments /-/old res T k- / Cv,�,/�a�/M,-•,t Standpipes (Y/N) —Air -tight Caps (Y/N) Foundation Cleanout (Y/N) Depression over Tank (Y/N) `�� Date Last Pumped -7,119 9 Pumping/Maintenance Contact on File (Y/N) _ ;for -Tt�ucs' Lf,�r Holding Tank High -Water Alarm (Y/N) _ -Temporary Holding Tank Permit (Y/N) Y �5 U31,S SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well —.� r To Building Foundation To Property Line �/U ` To Disposal Field _A To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course /00 % Comments Lo"F 04S L bl,t/6 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption S Date Installed Width of Field M IA- Type of System Design Length of Field Depth of Field — Gravel Bed Thickness Square Feet of Absortion Area Statndpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTIO IELD: To Water -Supply Well To Property Line To Building Foundation To Existing or Abandoned System on Lot ; On Adjoining Lots To Water Main/Service Line To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments Ln7– .HAY D. LIFT STA ON /� D t I t II a nsa e Size in Gallons "Pump On" Level High Water Alarm Le at Tested for Meets MOA Electrical Cod Comments '*Check Permi I certify that li inspection. Signed r Company Date MOA No, /N) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. room ating Against HAA Request" acke�veried. or conformed to all MOA and-�C r Receipt No.�"lJ "S� Receipt No. Date of Payment �y 2,r` � Waiver Fee: $ Amount: $ eq -7=t? 176;2, Date of Payment — 72-026 (Rev. 7/88) Back Page 2 of 2 effect on the date of this Engineer's Seal 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 G^ e 18,5- ^—_ 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) % 1 /C A PC /lUC It lj(y'we" 5 -c4 -A" Location (address or directions) (.t, -20l PO/106,(C Iri (b) Applicant NameJ "S7rZ I�- ARAf6 rr � �ofm_e, �' %_' 7 iness �?6 Telephone: H`"SCS Applicant Address %�� / �/��� ""rte `q (c) Applicant is (check one): Lending Institution D ; Owner/builder EY--, Buyer E) ; Other El (explain); —�— (d) Lending Institution%I tJ�i9T1°wlh� �J `�`i ir'v C/ Telephone C ' " � 0a Address 7'ij�jzj (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family K Multi -Family ❑ Other Number of Bedrooms ___. 3 3. WATER SUPPLY Individual Well VI Community © Public El 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 D Public El Community D Holding Tank o 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) 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 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"� � ,'Ghe�A-,? e ices/ �G6�lia uj_ Telephone _ 32et- -1.3Z —�_ Address _-s� LL Q f%/,+D !; - eA /�Ge /c V - Date - --- ---- �M®� �•'('°(s�e�•.. seo •ee•se�s-°•/�oje/yoJWa00•® �••"°••I.. i-°°°�° Viaeuo 00oT °a TI PEODORE F. MOORC e°• 9 Q in °.• Clc - 3589 w"AV w •• 47 Engineer's Seal 4 4 pfolossioO G. DHEP APPROVAL Approved for —bedrooms by ` _ ,.Ls �� rr Date - --- -� Approved __K_ Disapprove - 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 tending 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) _ ____.______--__- _—.—_.___._.-_.re._.«.e.,.n�---,�•,�szv.+m±�.a�im_ms_�mr�ar�A�0�01 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION(' HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 J U N 2,5 i,QR5 264-4720 �3,, Legal Description: '_'f ( (ve- k R4E G E N E Po ffe ck HmmeS><xrr,( .S"6 A. WELL DATA Well Classification F('(vY4_e' If A, B, C, D.E.C. Approved (Y/N) N'A' Well Log Present (Y/N) )' Date Completed 16'%'-31 9 Yield I I/`( ' "p, Total Depth `7-3 Cased to Depth of Grouting NeA. Static Water Level 12,5 Pump Set At -=' %/ R Casing Height Above Ground Sanitary Seal on Casing (Y/N) t Electrical Wiring in Conduit (Y/N) _ Y Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot 122 _ ; On Adjoining Lots IC -10 I _ To Nearest Edge of Absorption Field on Lot Nr A . _; On Adjoining Lots To Nearest Public Sewer Line NiA To Nearest Public Sewer Cleanout/Manhole A. To Nearest Sewer Service Line on Lot IVI/1. Water Sample Collected by '7717/1 ; Date — 5/23 46' Water Sample Test Results _5,e/ rf-"rY — 0 coh/or4t) Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size ,( ��U No. of Compartments Standpipes (AN)/?J Air tight Caps (Y/N) — Foundation Cleanout (Y/N) Depression over Tank (Y/N) _ Date Last Pumped 6'1 2 lam` Pumping/Maintenance Contract on File (Y/N) % — ; for -rS Q!cT CS Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank To Water -Supply Well —_U2_Qj To Building Foundation _ a To Property Line _ - _ To Disposal Field _Ak4- . To Water Main/Service Line M A. To Stream, Pond, Lake, or Major Drainage i Course Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA M4. Soils Rating in Absorption Strata Date Installed __ Width of Field Square Feet of Absorption Area Depression over Field (Y/N) Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments — D. LIFT STATION NA, Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present(Y/N) —_ Date of Last Adequacy Test _ To Property Line To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) 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 � -9�7—� Date 61/7–Y 4�_ Company MOA No. T Receipt No. �( >— DateofPayment PAuluo(9�(f1�5 �, OF At i9 «...... Amount:$ e'��/� •� ° ° •. Engineer's Seal q TH yd,�..��ffff'.'''''' .. a .... • ... • ./t�/.}�.Q..i�... A Page 2 of 2 4 THEODORE F. MOORE CE -35 90 E -35890 A' 72-026(11/8A) ��°F °•`•.....^•° Qp�^� 4�N®� ofessi ®® �i'1 CIVIL, & ENVIRONMENTAL ENGINEERING • ENERGY CONSERVATION & ANALYSIS THEODORE F. MOORE, P.E. July 25, 1985 14530 ECHO ST. PH: (907) 345-1355 ANCHORAGE, ALASKA 99516 Laura Ward/Susan Oswalt M.O.A. D.H.E.P. Pouch 6-650 Anchorage, Alaska 99502 Dear Ms's Ward and Oswalt: I am returning the holding tank inspection report for Lot 1, Block A, Pollock Homestead Subdivision with the additional information you requested. I did not require the installation of a cleanout at the 90 degree bend between the septic tank and the holding tank because there should not be any solids passing through that section of line. My understanding of the reason behind the requirement for cleanouts at 90 degree bends prior to the septic tank is allow for the removal of accumulations of such solids. With the frequent pumping occasioned by this being a holding tank situation, I cannot see any potential for solids passing through the septic tank, and hence I do not feel there is any need to install a cleanout at this location. Please call me if you have any questions or further problems with this matter. Sincerely, Ted Moore MUNICIPALITY OF ANCHORAGE! DEPT. OF HEALTH & ENVIROMAENTAL PROTECTION J U L '^ �i•i„ RECEIVED 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township,,,fange) U. Location (address or directions) (b) Applicant Name/Aaln 17 Telephone: Homei � s `C'2 -S' 7 Business 2---76 ' 153(:�S 5� Applicant Address (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder 2[; Buyer ❑ ; Other ❑ (explain); _ (d) Lendinglnstitution �c��Telephone Address /UULJ ct'" )�! h2 -O rvc'p ly n Z� _vc °�o�Z>, (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: / G-- (--' U,,n 2. TYPE OF RESIDENCE Single -Family,- Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual WellX , 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 Cl 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 72425 01 a4) 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 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 Address Date .— Telephone Engineer's Seal 6. DHEP APPROVAL Approved for J2-+ bedrooms by ate __- Approved _ Disa rov PP � —_ 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 MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE (MOA) DEPT. OF HEALTH & HEALTH AUTHORITY APPROVAL (HAA) ENVIRONMENTAL PROTECTION, CHECKLIST - FEBRUARY 1984 264-4720 JUN 1 11985 Legal Description: oaf l( 13 of ck Nomesh� Sub r �,-- - A. WELL DATA Well Classification F'rr'vc46 If A, B, C, D.E.C. Approved (Y/N) —N.A. Well Log Present (Y/N) Y Date Completed _ to / CY 119 C YieldI 'wom Total Depth 7 _ Cased to y6 Depth of Grouting Static Water Level _12.5 Sf Pump Set At � 7/ Casing Height Above Ground 8 rr�r A4 v m""(ed Qgr(A Sanitary Seal on Casing (Y/N) M e(u1 comer Electrical Wiring in Conduit (Y/N) . Y Depression Around Wellhead (Y/N) N. Separation Distances from Well: To Septic/Holding Tank on Lot /?_0 On Adjoining Lots To Nearest Edge of Absorption Field on Lot > ! 20 ` _ ; On Adjoining Lots > (00' To Nearest Public Sewer Line At.& To Nearest Public Sewer Cleanout/Manhole N.A. To Nearest Sewer Service Line on Lot a, A. _ Water Sample Collected by 7'rm ; Date Water Sample Test Results sc, (,.(f-�cc'4 ry - O co(r�vrm Comments We!( uaoertrr Av Se ?erfor,?1ra ce{ 33 #f B. SEPTIC/HOLDING TANK DATA Date Installed9 �� 18Z Size _L?Sa�_Pa! No. of Compartments Standpipes (Y/N) _ r Air -tight Caps (Y/N) _-Y Depression over Tank (Y/N) N Pumping/Maintenance Contract on File (Y/N) a Foundation Cleanout (Y/N) N Date Last Pumped ;for Holding Tank High -Water Alarm (Y/N) N.A. Temporary Holding Tank Permit (Y/N) N.R. Separation Distances from Septic/Holding Tank: To Water -Supply Well 120' To Property Line To Water Main/Service Line N, 4 To Building Foundation _ 7' To Disposal Field _!d' doer a✓- yur/( To Stream, Pond, Lake, or Major Drainage Course <—, 5yk ess roar ho(aih s o fin wu�E� Comments 2 noC c:(crgn-o«( f¢�,a�o�ar,(T cz+ve� 6v ecxrf� 2tccavice,<eo< {�� {vuncQafzory r�(lgrn sVsI-eon Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA 30 Q (3�r^' Type of System Design ) louaa� Soils Rating in Absorption Strata - per Qi_ 76 Ff Date Installed 9 / e5 /8a Length of Field 6o Depth of Field '/' Width of Field Gravel Bed Thickness Square Feet of Absorption Area ado a Standpipes Present (Y/N) `f ry Date of Last Adequacy "festAt0^e ;-revrou✓ Depression over Field (Y/N) Results of Last Adequacy Test N •A• Separation Distance from Absorption Field: To Water -Supply Well � r 30' To Property Line N 5 — To Existing or Abandoned System on To Building Foundation � 20' Al, A A. ; On Adjoining Lots - 30' Lot To Water Main/Service Line N.A. To Cutbank (if present) N, d , lwte To Stream/Pond/Lake/or Major Drainage Course 32, ver vri,nor rain e 80 >0 fa a ,11ao w� i nd',�' afer To Driveway, Parking Area, or Vehicle Storage Area 30 ' ��� �f7 aA ett-�usaes ryaf d Comments uund Cvn riKtrwhb,b v SLjawn D. LIFT STATION Date Installed — Dimensions Size in Gallons -- Manhole/Access (Y/N) _ .,Pump On" Level at ,Pump Off' Level at High Water Alarm Level at Vent (Y/N) -- Tested for _ — Pumping Cycles during Adequacy Test, Meets MOA Electrical Codes (Y/N) Comments ** 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 Date Cl 7 � �— es- company s Company r Ti! (c? � Iy e_4 �c� MOA No. 12 Receipt No. Date of Payment �t_ PXinAk ` RI •, ,,.`i�+. Amount: $ �'. • °. Or ,� Page 2 of 2 72-026 (11164) POW *(-/sus •'ar9TH •vp ; 4 o THEODORE F. MOORED+ 0 © c®v�'•UPpD /CE - 3589 qua' June 10, 1985 152'0i Pollock_ Drive Anchorage, Alaska 99516 IPept. of Health and Human Services 825 L Street Anchorage, Alaska 99502 Attn. Robert Robinson Re.- Septic System on Lot 11 Block A, Pollock: Homested Subdivision Dear- Mr. Robinson. Thoma attached Health Authority Approval Checklist indicates i..hat the absorption field does not meet -the regUirements of the Municipality of Anchorage, however this system has been in operation since Oc-t 1904 without any failure. After 'the failure I contacted Tobben Spur(ela'Yd, the engineer that designed the system, tea get an secc'rYd option. As you car' see in the attached letter Mr. Spurk:land confirmed the earlier test. As I stated before the system has performed as designed since 1 have lived in the house. The only reason that I had the: test performed was that I am refinancing my home, Clr-' Jun" 10, 1905 I discussed the test results with Mr John Kennedy, of Your Office. At that time I told Mr-. Kennedy that I could not afford to install --a completely new system at this time but at any time that the system were to show signs of failure I would the apporiate measures to correct the sys'tem.. The approval that I am seeking is for the approval of my syste'Yi for the purpose of refinancing of my home. If at any time that I were to sell my home I would insure that the system meet all the rE? uir-!?ilY4_'it5. +f)ffic�r DBarnett. e� .- (;ice_ 7r % {�?v'�'•t_ 1j��jUU ice. CONSoULTinn ING 5 m t G `i�m�( my IpQ1 (A MR. H.D.BARNETT 15201 Pollock Drive Anchorage, Alaska 99516 ac -- 203 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279-3916 JUNE 10, 1985 Re: Septic System on Lot 1, Block A, Pollock Subdivision Dear Mr. Barnett; Per your request I inspected and tested your septic system on June 6, 1985. My inspection of the system did not find any indications that the system was not able to handle the waste generated by your residence. The design of this system is such that any overloading and subsequent failure of the system would be readily appearant. I also tested the system to see if it had the overload capability specified by the Municipal Code. I added approximately 150 gallons of water to the system over a three hour period and monitored the water level in the bed. After six hours approximately half of the added liquid had been absorbed. This is not sufficient to meet the Municipal requirements. However the system is sufficient for the present loading. Yours kit o. 2225-E ty� UNE no ,1971 � APPLIC NT FILLS OUT UPPER HAI ONLY Time Property Owner C' D -P) � - —141) A" y J /L>! 0 YJ Phone Mailing Address �—-/`z Zip Code^ �• e- - DateDate Buyer Date r ' Date Address Zip Code Inspector Lending Institution�r , z- -kJr,• e f-" -,�'o C_,[tDA Phone Address :� � "`— �'-'�� i � ��. _ `�/e_-.. Zip Coder` .—rs._v Realty Co. & Agent / Phone Address Zip Code Legal Description MUNICIPALITY OF ANCHORAGE Street Location -y�ri DEoT Or ; " ' IT,' R. -D-�"�, Type of Residence f �. i•k)�� J_4Hngle Family .a ,� ❑ Multiple Family No. of Bedrooms R RECEIVED ❑ Other 'CONDITIONS OF APPROVAL Water Supply ndividual �� ��t� ��� h EI Community ATTACH WELL LOG. A well log Is required for all wells drilled since June 1975. ❑ Public Utility For wells drilled prior to that date, give well depth (attach log if available). Sewer Disposal �J IfIdlvldual "A LI_,,�J Year Individual Installed: / ❑ Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Septic Tank Size ACa11f1 n n Time Time Time Time DateDate fib"8 � Date r ' Date Inspector Inspector Inspector � 11- _ -SS's (f "A Inspector` D(CL Field Notes: q 1 1-i MUNICIPALITY OF ANCHORAGE DEoT Or ; " ' IT,' R. f �. i•k)�� .a ,� R RECEIVED ( 3) APPROVED BEDROOMSj/(I DISAPPROVEDS) 'CONDITIONS OF APPROVAL CONDITIONAL APPROVALDATE�{� Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size ] .23 131821