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RABBIT CREEK VIEW & HEIGHTS BLK 5H LT 3A
Rabbit Creek View Heights Block 5H Lot 3A #020-551-38 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ONSITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES — �/�tYJM� TO &S'RC►I'-s-P ABSO PTION WELL Address � � _1 FROM FI LD Phones)Per y^� nht No. No- of Bedrooms WELL � tSC- � ��- V ( DV LEGALD��Q`" DESCRIPTION LOT LINE 5bI Lot— Block Subdivision — FOUNDATION Township, Range, Section — II AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, I , v " � � l I ✓ " driveway, water homes, etc.) TANKS ❑ SEPTIC HOLDING Capacity in gallons Manufacturer Capacity J \ . lCA ` Mate r — No. of Compliftments -- TYPE OF SYSTEM — G ❑ TRENCH ❑ BED ❑ W. DRAIN ❑ OTHER Depth to pipe bottom from Total depth from original grade 1 ) original grade FTFT 1 Fill added above original grade Gra 1 depth beneath pipe 1 FT FT � Gravel length Gravel width ki& FT Total absorption area Disl a between lines /SO FT FTNumber Y of lines Soil ratingPipe material SQ FT Installer Date Installed 1 WELLS — ❑ PRIVATE ❑ OTHER (identiiv) Classification (A,B,C) Total Depth Cased to _ FT FT Installer Date Installed: / REMARKS: 1 � 1 e—t 1n'1rl Scale: ��xYINS S �� Cir w1.4 1'JrC.C2�- InspeClloo n�Perfoim�eo by: .............• �gs�eq� — Date.$ 491:1. ,..•r ... ...............a. Icertify that This inspection was performed according to all r11J �� ;a MAR W. PEARSOIJ 'e\2 Ot Px CE - 7760 ;.• j Municipal and State guidelines in effect on [his date: o — d� Ji��^.,y Health Department Approval: Date: 7) m fj oe J' Q) 7l-�- \0 0� N vv'n� ,$) J f� JnVg r- O own bepartme�t o� Hea1th � Humaes U25 L Stre t A h Al k 99501 343 4���'/���/ GN-SIT� �|OLD{NG Permit Number: 900091 Upgrade Da�e 1ssued: 05/07/90 Engineer Deszgned TA K PERMlT �- /~7-c' �wner Name: F N M A P, i/wner �ddress: 81�`7 BYRON 696�170V HNCHUkA6E, AK 9951� /`arcel �d: O20`1�2-1b Lo� Loga1: Sub�ivzsLon: RA88lT CRELK HEIGH/S Lo�: 3 Block: 5 Section: 1 Township: 11q Kange: 3W Lot Szze 2��U7 (sq.{t. or acres/ �|ax Bedrooms: [�zs Permit: 2 ToLa1 Capacity: � HOLD1NG �ANK: Mzn�omm Tank Size: 2�o00 gallons. A high water a1ar1 must be �nsia�|ed on Lh� Lank and connec�ed Lo Lhe residence. Depth to top oi holding /an! � 4o !eet r+quires �ns'�]ation over tank. PERM|| E�PiKES [�ECEM8ER 31, l990. `3*L��~�/T H1/�H WA!�R �L�RM MUSl 8E WlRED INlO DWU.LING. " ���'� PRUPLKLY ABANDON EXIST11.G S�PTIC TAN� AND A8SORPT[ON FIELD' �- /~7-c' CD n•- > w o \ 'E 0`a cs — �\ d1 v m o 0 0 •- Q (n N d y m 7 m d 0 nj�y m a 7\ E rn— co _ m m Em�Co °ho O O N O L N i0 C1 C0 0— M 9 i C O _ O N ° � C u c in pco co N O p p �4y O co t o rJ� Ln v •- c� i \ r 1 •� T Y UJ U N / \ O d ) rj \ O / 0 J O UL i 1 � c -aYi 1 11 Q 1 ' 0 LU MOUNTAIN ENGINEERING 10251 Crestview East • Eagle River, Alaska 99577 Anchorage 907-696-1700 Outside Anchorage 800-478-0101 ;ii MUNICIPALITY OF ANCHORA(39 May 3, 1990 i': T. of HEALTH & k.'. -AMINTAL PROTECTION 4 Ms. Susan Oswalt MAY logo Municipality of Anchorage ��,��U�� On -Site Services 1 825 L St. Anchorage, AK 99519 Re: Lot 3, Block 5, Rabbit Creek Heights, 8127 Byron Holding Tank Permit Dear Susan: Per our telephone conversation of 5/1/90, this letter explains the holding tank permit application we have submitted for the above -referenced lot. Mountain Engineering has performed adequacy testing on the existing system on the lot, and the system has failed. Before the test began, the static fluid level in the drainfield standpipe was only 11" below the ground surface. After adding .less than 100 gallons of water, the fluid level rose above the ground level, surfaced next to the pipe and began streaming downhill (to the east). The lot immediately to the east has a water well approximately 110 feet from the drainfield overflow. I spoke with the neighbor of the adjacent lot and he indicated that when the house (on the system being tested) was occupied, a continuous stream of fluid ran down the hill toward his well. He had done some trenching in an effort to divert the flow away from his well. Due to the 100' radius from -the well on Lot 3 and the adjacent lot, the space available for a new drainfield is severely restricted. I excavated several test holes in the available area, and found the soils to be unsuitable; consisting of an organic mat (6" to 12" thick) over clay. In all. test holes, the groundwater was 4" to 6" below the surface. We therefore feel that a conventional septic system is not feasible, and recommend a holding tank. The property is not located on one of the steep roads in the area and should be accessible to pump trucks in the winter. The lot to the east has been using a holding tank for several years. Rabbit Creek Heights, Lot 3, .Block 5 Page 2 Please contact me at 696-1700 if you will need any additional information. Sincerely, Mark Pearson, P.L. 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 ^ ®®� ®� Un�,r? 1���1!\.I fIG PHONE Z�% NEW 7:1 UPGRADE MAILING ADDRESS lr 7 LEGAL DESCRIPTION Lor 3_(!&K 14 r5 T 1 1 4 r� "3,vj LOCATION NO. OF BEDROOMS AAG�ICi)®-to c'07 O Y DISTANCE TO: Well - Absorption rea Dwelling / ' � PE IT Np _ lt- S 2- -may q— ,-Y V�a Z N H Manufacturer 1� At4c EClfil�6_6 ""I Matera r No. of ct-o No. p rtments Liqgapaby in gallons 11 IF HOMEMADE: v Inside length Width �/� U A Liquid depth ,f L. O �' C7 2 DISTANCE TO: Well Dwelling PERMIT NOS Z h Manufacturer Material Liquid capacity in gallons w Well f �h ' / Foundation �� / Nearest lot line DISTANCE TO: I V� �- 6 / '" r PE M T NO. _ �� O ; w U, P z No. of lines Length of each I't Total length o li es T-^�-=-^' 9 ya -AL/ 9 �p Z �$fe •J Distance between lines 0 — Top of tile to finish grade M terial beneath the / s� r Total effect ab ption ares 0 w LengthWidth Depth PERMIT NO. 0 �' 4 h to ° Type of crib Crib diame - Crib depth Total effective absorption area in DISTANCE TO: Well Building foundation Nearest lot line d Class Depth Building fow ti - Driller Sewer line °Od°7/� PERMIT NO. DISTANCE TO: n °gym@4a°nk Absorption area(s) OTHER eo° ao 00 0°°° uet G PIPE MATERIALS Cl -� °o ooeoo° ex° O Ag -t7 a SOILTESTFfATING -I'M ° °' 24 ••E IL MA�T`L- I?� , A°nVi ° eO• eee °°° 47 INSTALLERV� RE=MARKS (p' 0c(AVA_O ah/ Ar sl Via- AtW1 Wk- — r� I<z;12uc_rw lir- 6m_ yAf u<i SVSim1 MSM( -CED q,5 06t eM11W ay -lwt2:fl 6��-'z�,/. ,1 r 6*ttfll y a 61L? --w Pr�.� pj . APPROVED DATE LEGAL 72-013 (Rev. 3178) IM PA X C." *]: P� af�� L.. T "T' `d' U3 F' PW H �,, I C: tA C3 IFRI iiCw C EE -i" ^� DEPARTMENT OF HEAL.TH AND ENVIRONMENTAL. PROTECTION 825 L GTQEETv ANCHORAGE, AK 99501 264~4720 C:3 H%H 3 E`: toJ] E_ R' �E'H"�Irl 1 -T PERMIT NO: 840527 ENG INEERED.DESIGN'`\ DATE ISSUED: 06/29/84 APPLICANT: RICHARD MORRISON ADDRESS: P.O. BOX 699 ANCHORAGE� AK 99510 CONTACT PHONE: 268 --- 8856 LEGAL DEGCRIP: SUB�IVISION: RABBIT CREEK HEIGHTS LOT: 3 BLOCK: 5 S�CTION: 1 TOWNSHIP: 111\1 RANGE: 3W LOT SIZE: 19500 (SQ°FT" OR ACRES) I certify that: �. I all, famili�ar With the� requirements for on—mite 5ewers and wells as set forth by the Municipality of Anchorage (MOA) and the State of' Alaska. 2" I will system in accordaince with all MOA c0des and regulatiolvs, and in compliance with the dc-:�sign criteria of' this permit, 3" I will adhc�pe to all MOA and State of Alaska for thta set back distances from any existing wel1� wastewater disposal system or, public sewerage system cm this or any adjacent or, nearby lot" IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODESq THEN (1) AN ELECTRICAL PERMIT AND INGPECTION MUST BE OBTAINED; (2) AS—�JILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST B ED ELECTRICIAN., SIGNED APPLICANT: RICHARD MORRISON IS8UED BYDATE: / ' 00 (Y i MUNICIPALITY OF ANCHORAGE Department Health and Environmenta: rotection 825 L Street, Anchorage, AK. _.501 264-4720 ]hermit #Z��'3�` HANDWRITTEN PERMIT # WELL AND/OR ON-SITE SEWER PERMIT Applicant: ,0161-1,440 6� �� Qi. Mailing Address: cI �'5l0 Location: Ec. /- % I) AVv- ,0-�3 ui U/�'r Phone Number: Legal Description:(? /` 1/�/;�% � ccK � Ts Lot Size: (V' J��%n Wit Type of: Soil Absorption System Is: Trench: Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: _ Soil Rating(sq.ft/br) Z6,— DEPTH The Required Size of the Soil Absorption System Is: LENGTH GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation (in feet) . m-00- * * REQUIRED SE-P_-"rI=C-(HOLDING) TANK SIZE = 45&-�10 GALLONS # # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * *.* TWO(Z) INSPECTIONS ARE REQUIRED # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of: the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 3 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residen is remodeled to include more tha3 bedrooms,/ S ignea : �� ��� �������' Issued by Applicant al ( c (-ck_u_. � Date: L4( CL &C -Z (1/81) SWP 024 � _; �c ��� ec( / � fv0°'r �rlra7 1 X(' ��s'c's��v i t i-� ✓ Co F- F -+J p'..,p "-- F -p w-° Fn`» N --N C:1Ef='Hfr:T[1EI'•d`f' i IL:f-1L_"flI f71'dC• Erd';'I r:iirdYiEr,[l`t-n_. ITECTI-_IN n a. 'L.' _ f-FTEE'I`, f"11'4l:.:1-10 RAGE, Ah. : 95 (DA. 264. 4720 L-0E--L_I _. N V.0 K':- n. ufi-"p---YWe 1 -VE-_::::="E"N.,0P: Fes» E-_"E-H.F.rl I —l... A P P L.T. C AN1- E:I C HARE.', C MCIRR I'=;OI'•d PO BO.","' 69'9 99510 a•- ;� 68—:`�t_f56 i i L f l" I 0r•d - L.EGFiL B5 L:_--, F::FIE:E:II- CREE:k; FIT.5 LOT 514"'E :;9'-.I:-_-:_1 :: 1JARE. F-EET l'','F,F-. OF' SOIL AB,_OF:PT'IrXj ::.:Y,_;TEM IS: DRAINFIELD HAi".I[-It-I[9 rIUI BER Clf BEDROI.:IMS = _ m;OIL RATIN, (SG! FT;'BR)= 26;5 THE I :E:I_!i_I1 RED ':SIZE OF THE '_�::;i'D I L. 1=iBSC-IRPT I ON Y. TEM IS: : Jr..""F:. p::-:" -.p...9 -H : .: t w: p _ �: 0' 4 u,=i 7" p.._p .:N_ -:Z - p_ C__i F•° N=N "•e° REE I__ IL -OF F' -1-1-A== THE L_ENId 3iTH D I ME hIS I CIN I ` , THE LENGTH (.' I N FEET) OF THE TRIwr•dCH OR Df::A U -IF I EI._f.). THE 1:1EP-11.1 !=1F A TRE1'•dC:H iiF:, PIT IS 'rHE DISTANCE BETWEEN I -HE UF,F HCE i iF' THE: 13ROI_IND FIND `THE 1:::OI_TO111 OF• THE: E��;!_FtVATIOr•-I (IN FEET).p._ 9 A IE_ "N` VRUE 1%# � �= F -N 1_�A I EN -T- H 1"°= � „ _ gild ®-u a,-. I _ _ THE GIRF"Oo'EL. DEPTH IS THE MINIMUM DEPTH C -If C3F., 1'y'EL. BETWEE:I'-d "ME f il_ITF`A1_L F='IF'E: Ai -xi THE BOTTOM OF THE E 1.:CA ;'FITIOh1 (IN FEET). _p'_ N= N 6'-4 N' 1 = J- _ • W.._ Wfl_. 11-7-51 C1u 11 u:_:.n F1 L__ p.__ PERMIT I'if-'F'L..I I :i=lhdl' HAS THE RE SPOr• S I B I L I T',' Ti i INFORM THIS DEPARTMENT DI._Ih:I NI_3 THE INSPECTION:-,:-, OF F[Y•-Ik' [lIELLS FIC: JACErd_f. TO THIS f"'ROPERT'r' F=11'+ICS I`I-IE I' U_IP'IE EF: OF` RESIDENCE:: THAT THE 14EL.L WILL SERVE. p.4 u: 1 it •4 '� F-° EE C "p If= u:�� p" p '. m- N=om IFS» F_ F==° Q = u=:=v N_N 7L Nom° E : OH J,"F I LL.. I YdG OF Ftr•d'r : 1-YI TE['I b1I TI-ICiI_ T 17'11, -JAL INSPECTION FII' D FIF'PF:Ci'; AL BY TI I l: E-EPARTMENT I-dIL_I._ BE Si_IBJE-1WT TO PF.MSECUTION. I'1I1'•d I HL.I11 D I'' �TFU'dl_ E BETk1EEN A 1-dEL.l_ AND ANY i::1lJ-- S I TE SEWAGE D ISPOSAL_ ' �'rISTEM :f 1.00 FEET F'!:R H PRI'v'ATE WELLOR 150 TO 200 FEET FFr:OI-1 A PUBLIC WELL DEPENDING LIF'i::N THE TYPE: 0F. PUBLIC WELL. M:L N I HI_R'1 DISTANCE FF:�. M A PRIVATE WE'LL TO A PRIVATE SEWER LINE IS 2`:, FEET f"11'•D I'0 A Cf-IMMi_NIT'•r' SEkIER LINE IS "5 FEET. WELL LClli::a ARE REGI_ RED A114 > [`U._S]" BE RETURNED TO THE C?L.PART11E:Y•a-f WI THIN -:1_i C;F14'.-1 OF THE 14EF._L. COMPLE T I i ii'•d. OTHEF:f:Ea11_1IF:F_T9EY,IT- I"'IFI',' 1=iF'F'L.','. SPECIF'Tc1-1"I"IOrd:_; FIr+IC; , i_1p,lE;l"F:I_IC:"FTOY,I DIFIGRAYIS ARE FiwAIL..ABLE TO INSURE F'k:O1*'1EF:: I1,1STALLATION. p -T- C. -E e =: F" :C p ^:° 4_� 7 '' " G n IF- . ur HE -1.1 pH- EE FZ? :ll_ I C:E[;:-F I f=',' THF -IT 1.: I AH f -AM I L I AR I.d I TH THE: F::EQU I F::EIIEr•-ITS. F'OR ON --SITE 'SEWEFr S AND 1,%1ELLS AS SET FOF. TI -1 B`r' THE: I'11_[Yd I C:I PALI T',! CIF' ANCHORAGE. 2: I 1 -JILL INSTALL THE SYS T E 11 IN A C OI C: AP-1ia E WITH THE C:ODE-» �. -5: I Ll1•d1::1ERSTFI1lJD THAT THE Ohl --';ITE: SEWER 'Sli-ISTEPI 1,1A ' REQUIRE ENLARGEFIEhff IF' THE: f7?E[ ICiG!EL.E E: ._ �+ I r•di: LLif:!E HORE THAN BEDF'OOMI . = s , A F,PL:E��tINT RIC-:HARD�-: ILII"IRRI�,,�,�1_..___. 3 —. tic ✓ aA-) G,' .Permit #: 820865 January 31, 1983 TO: Permit Applicant Subject: hoL 2 Block 5 Rabbit Creek Heights Subdivision A permit issued by this department for an individual well and/or on= -site sewer system has expired as of: December 31, 1.982. Permits are issued on a calendar year basis, as stated on the permit, by authority of :Municipal Ordinance. If you have drilled the well, a well log needs to be sent to this department for documentation of the installation date and to close the permit. ]:f a private engineer_ inspected the installation of the on-site sewer system, please have them send us the as-buil.ts for our files and documentation. If there are any further questions, please call this office at 264-4720. Sincerely Robert C. Pratt, R.S. Acting Program Manager Sewer and YYater Program RCP/ ? ;� enc: copy of Permit SWP/0 51 I +i•F I (i lj a��..'L �,h:,�!L April 2.2, 1983 h •1CFiORAGE. ALASKA 99_i02-0650 00 i) 264_,; 1 1 +, M of Iw'•[ rJ I O'r-IFi;I_ III (i(`16 FNVIfi6 n f NITAI_ F OFiz:I ION Lot 3 Block 5 Rabbit Creek Heights #830089 Richard C. Morrison Post Office Box 699 Anchorage, Alaska 99510 Subject: Rabbit Creek Heights Subdivision Rabbit Creek View Subdivision hccordir:g to our records, your were recently issued a per.mi.t Lor "on-site sewage disposal" in either the Rabbit Creek View or Rabbit Creek Pieights Subdivision, and have not yet completed consLrucl-:ion of the disposal. system. Due to discrepancies in the original survey, there may be appreciable errors in; lot lines, lot corners, streets, r.g1_it of -ways, etc., v;hich would result in :i.mproper placement of the ,;cisteviater cisposal. system. We are not, at this time, rescinding your permit. however, we do wish to caution you Lo be cer_Lain of your lot lines, corners and configuration before installing your wasLewaler disposal system. If such a system were installed and subsequent lot line changes were necessary, it is then possible that the system would have Lo be re _soca ted . In v.i.ev; of these_ existing problems, with the original survey, this office has discontinued the issuance of on --site sewage disposal permits unLil the problems have been addressed and cor_recLed . 1i there are any I-ur.Lher ouestions, please call tris office at 264-4720. Sincerely, �t�r-"�'��W�1 ,sem-`'' l��t�yL=:✓s�-- _____ Robert W. Robinson Environmental Lngi_ncer.ing Manager attachmenL MUNICIPALITY OF ANCHORAGE (j - Department Health and Environmenta rotection 825 L Street, Anchoraqe, AK. �,.)501 - 264--4720 * * * HANDWRITTEN PERMIT * * Permit �.�C�o( .> WELL AND/_ ON-SITE SEWER PERMIT Applicant: Mailing Address: Location: ti Phone Number: `'�J��� = ��' Legal Description: (� _� � �C (': i_l.f -� �_� Gc /�/-E; Lot Size: Type of Soil Absorption System Is: Trench: Drainfiel.d:-_ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: ,.� Soil Rating(sq.ft/br) DEPTH The Required Size of the Soil Absorption System Is: LENGTH -GRAVEL DEPTH WIDTH ) _ The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ /<(L _ GALLONS # Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED # # Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 2 I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residen e -is remodeled to include more that 3 bedrooms Signed: �L//�ii��l'' 2<.-- Issued by: Applicant Date: SWP/024 (1/81)7L�ll `CC SOILS LOG - MUNICIPALITY OF ANCHORAGE nP e +�' DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 ' SOILS LOG -- PERCOLATION TEST PERFORMED FOR: K11f 1'V� DATE PERFORMED:282 LEGALDESCRIPTION:_ SLOPE SITE PLAN '1Fl E0I1 1 - 2 (�I L — ver Mir st 3 4 7 a 9 10_ - 11 12 - 13 14- 15 16 17 18- 19- 20- COMMENTS s1920COMMENTS f Aiyo l Date �- Net Time Depth to Water Net Drop t K2C I, ""o WAS GROUND WATER L ENCOUNTERED? IC_.� O P IF YES, AT WHAT lot, E DEPTH? �h� Reading Date Gross Time Net Time Depth to Water Net Drop t K2C I, ""o 12', (4 d �f/y�( 6 G � � 6 H z0 r2 : '51 `f9 5 ( !01 _10 rnirN q5 t Hz () 1,b5 (�.S )J -25 5n Ib i -A, 16) C>� 8IL Reading Date Gross Time Net Time Depth to Water Net Drop t K2C I, ""o 12', (4 d �f/y�( 6 G � � 6 H z0 r2 : '51 `f9 5 ( !01 _10 rnirN q5 t Hz () 1,b5 (�.S )J -25 5n Ib i -A, 16) C>� PERCkATION RATE i , (minutes/inch) TEST RUN BETWEEN FT AND 112— 2— FT D rem ii is 'er 1J PERFORMED BY:Connor) = chrrr_D —CERTIFIED BY: 72-008 (6/79) DATE: �✓ G - y,r- COUii opgtu fiIll S�11.fio i'01 0LA 1 10 TEST DATA SHEFT CLIENT .._I-��-���1=:�. - - ! - ._._- UA-ic . A.J9__ kfjq ��� LI1 CODE .,.,._i LGAI I.00Af'10 a 1 OTAk up w or 11,:;x_ r 1. . ZCPdF TESTED 1,21 0 ft FINAL PERCOLATION RATE. � 5" �� (min/ -1n) PFRFOR14ED BY F' - I ' - u1.-.horUge, (sl,sir 0 jgilll )�+1} 13ra RrADING 11 CLOCK TIME! ''I:' ' 1MI I DEPM V NET PROP �RAIE (min/in) } 47-0 116 01 W) N -0 4. f 11 ;_ lo mol r 16 �1 l l) _ flzz} i Ur? FINAL PERCOLATION RATE. � 5" �� (min/ -1n) PFRFOR14ED BY F' - I ' - u1.-.horUge, (sl,sir 0 jgilll )�+1} 13ra 1 11 VV A J 1- )� Yll % L G 20(-, �iy, �, ' , ll 1 Alv)-U;9 ")Sc /4�i1=51/fly �• (>) A1, MUNICIPALITY OF ANCHORAGE DEPT. OF i!-,,' [I ^ ENVIRONfi1--NlA1- PKJfLl:HON ilq oV 6 1 11 \\ Municipality of Anchorage 1s 4" -� Development Services Department Building Safety Division =' On -Site Water and Wastewater Program s „ 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. COSA# Expiration Date: / — 3 " O q 1. GENERAL INFORMATION Complete legal description Rawl • crppb lle0I, B& S Lo ,±t:: X Location (site address) $121 Bgror Dr*ve. Current Propertyowner(s) Ginkpr Pow`II Day phone g9D-400 Mailing address Lending agency Mailing address Real Estate Agent Mailing Address Day phone 9-kk, grc. xt Day phone 22I-Ra40 Unless otherwise requested, COSA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System 2 TYPE OF WASTEWATER DISPOSAL: CK Individual On-site ❑ ❑ Individual Holding Tank ❑ Community On-site ❑ ❑ Public Sewer ❑ 1_5 The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage Is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm Sisr"-bA !A4^ea f164 Address 103 W, I5i' Ad, Sto_ 201 1 ncLorfj! AK 59501 Engineer's Printed Name LA2s Sfh'A-210,^ N. 5. DSD SIGNATURE --- _1_0� Approved for bedrooms. Disapproved. Phone 1.19 — 391(0 Date - zo 0 % �P��YOF ACq !f9111/ i 49TH spuRKtAND; i Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: Original Certificate Date:_g — 3 (Rev 77105) Municipality of Anchorage o• Development Services Department Building Safety Division --- On -Site Water & Wastewater Program 4700 Elmore Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST 3 R�1 Legal Description: 1A l A 146 11.:.M s Gk5 616A Parcel ID:02O —3511 3$ A. WELL DATA Well type 1P6%%'AFO If A. B, or C provide PWSID f1= Date completed Map Sanitary seal (Y/N) Total depth 11Z ft. Cased to 112 ft. FROM WELL LOG Date of test tf 1563 Static water level rzFe6m" ft. Well production w — Z 5 9— p.m-WATER SAMPLE RESULTS: Coliform colonies/100 mL Nitrate _, mg/L Arsenic: ND ug/L date of sample: 29 oq B. SEPTICIJOLDING TANK DAT Well Log (YIN) Y Wires properly protected (YIN) Y Casing height (above ground) +1q in. AT INSPECTION Z9 2Cbry Aro&!5;aan ft. 3-5 9— p.m- Other bacteria _RL— colonies/100 mL Collected by: L A25 SaUr We%"A Tank Type/Material 51eel I nchoravv Date installed S/30/14 90 Tank size 3c00 gal. Number of Compartments Cleanouts (YIN) Y Foundation cleanout (Y/N) M? Depression over tank (Y/N) _!AL High water alarm (Y/N) y Date of pumping IS oy Pumper Tfi a s Rur+yinu Ser V.Len' C. ABSORPTION FIELD DATA Date installed Length — ft. Soil rating (g.p.d./ft2 or ft2/bdrm) — Width ft. System type -- Gravel below pipe ft. Total depth = ft. Eff. absorption area _n2 Monitoring tube = Depression over field = Date of adequacy test Results (Pass/Fail) For —bedrooms Fluid depth in absorption field before test = in. Water added= gal. New depth= in. Elapsed Time: = min. Final fluid depth = in. Absorption rate >= g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) If yes, give date + C4Z. Ow} '%n Crawl Spm D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on' level at in. `Pump off" level atin. High water alarm level at in. Datum Cycles tested Meets alarm 8 circuit requireme 7 E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot Absorption field on lot Public sewer main I Sewer /septic service line 1S + Animal containment areas On adjacent lots On adjacent tots Public sewer manhole/cleanout Holding tank Manure/animal excrete storage areas — SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5I+ Property line 5 + Absorption field Water main A114 Water service line Z 5 + Surface water /✓. O, Wells on adjacent lots ICO # SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line' -- Water Service line Curtain drain F. COMMENTS Building foundation — Water main Surface water Wells on adjacent lots _ Driveway, parking/vehicle storage G. ENGINEER'S CERTIFICATION 1 certify that / have determined through field inspections and y'L}gTH review of Municipal records that the above systems are in .. ` conformance with MOA COSA guidelines in effect on this date. �� • LA IS . SRURKLA Engineer's Printed Name LAS SPA Afi j DateIN "t'ZOIat (Il`�`cOFfiFESSi���r��_� 1 r COSA Fee $ 990 0o Waiver Fee $ Date of Payment -JIVcf Date of Payment Receipt Numbero'f91z� MV Receipt Number (Rev. 11/05) SGS ReEN 1093081001 Client Name Spurkland Engineering Project NamelN Rabbit Creek I leights B5,L3A Client Sample ID Rabbit Creek Ilcights B5,L3A Matrix Drinking Water Sample Remarks: Printed Date/Time Collected Date/rime Received Date/rime Technical Director 07/092009 13:47 06292009 11:45 06292009 12:10 Stephen C. Ede Allowable Prep Analysis Parameter Results PQI, Units Method Container ID Limits Date Date Init Metals by ICP/MS Arsenic ND 5.00 ug/L EP200.8 C (<10) 07/06/09 07/08109 NRB Waters Department Total Nitmte/Nitrite-N Microbiology Laboratory Colony Count Total Colif(wm Fecal Coliform ND 0.100 mg/l. SM204500NO3-F B (<10) 07/02/09 LCE 0 col/100mL SN120922211 A (<200) 0629/09 SDP 0 col/100ml. SM2092228 A (<I) 0629/09 SDP 0 col/100mL SN120922211 A (<1) 06/29/09 SDP 07115109 Type Tate.Cryatal invoice Payment Invoice Payment Invoice Invoice Invoke Payment Invoke Paymerd Invoke Invoke Isaacs Pumping Service Date Num P. 0. # 107612008 13547 10105108 10131/2008 11/1812008 13739 11116108 12124/2008 12/2912008 13835 12123108 112112009 13924 1121109 3M2009 14036 2!24109 312!2009 411/2009 14145 31310 41102009 5111/2909 14301 514!09 6/122009 14509 611C109 8 I �.'1 (�)y <. D 1'1 �U-i-.,(\ � L�n OIA-n Page 1 110.00 110.00 110.00 110.00 125.00 110.00 125.00 235.00 110.00 235.00 110.00 110.00 �C'A 07/15109 Isaacs Pumping Service Type Date Num P. 0.11 Amount Powell.clinton V1 Payment 31102008 190.00 Invoke 31182008 11129 31171% 95.00 Payment 41912008 95.00 Invoice 5152008 10634 MOB 95.00 Payment 5282008 95.00 Invoice 6/1'2008 10374 528108 95.00 Payment 6/232008 1004 95.00 Invoice 7/1/2006 13313 6130108 110.00 Payment 71102008 1007 110.00 Invoice 91112008 13740 827PJ8 110.00 Payment 9222008 1027 110.00 Page 1 MUNICIPALITY OF ANCHORAGE • y° Department of Health & Human Services r R DIVISION OF ENVIRONMENTAL SERVICES �- 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel l.D.#_s��— 11ci' 1(� HAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Rabbit Creek Heights, Lot 3, Block 5 Location (address or directions) 8127 Byron Drive, Anchorage (b) Property owner Mailing Address (c) Lending Institution Mailing Address Telephone: (home) --Business Telephone (d) Real Estate Company and Agent Fannie Mae, Nancy Gilbert Address 3601 C. St . , Anchorage Telephone 561-0828. (e) Mail the HAA to the following address: (or check here, if hold for pick up.) List contact person and day phone number below: Contact Mtn. Engineering @ 696-1700 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3 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 thlegality-an d status. d. 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 3 1 Z abed 8098 (BOLL 'nay) 990-ZL -� joM s,daaul6ua Ieuolssa;oid ayl uI suoissiwo ao saoaaa ao} alglsuodsaa lou sl a6ejoyouy;o AllledlolunW ayl'panssl sl aleol}Iljao a aao}aq elep azAleue jo suoi;oadsui;onpuoo lou op SHHO;o saaAoldw3 •sluawaalnbaa alels pue Ieaapa; uieliao A}slles o; iepio ul suoilnl!lsul 6ulpual dlayl pue sawoy ;o sieseyodnd of Asolinoo a se slyl saop SHHO ayl TNsely ;o alelS ayl uI paaalslbeJ daaulbuo leuoisseloid luopuadepul ue Aq anoge 9 ydoiBejed uI uan16 suoileluesaadai ayl uodn Aluo paseq paleoilpeo IenoaddyAl!aoglny ylleaH sanss! (SHHO) SaolnaaS uewnH pue ylleaH;o luawlaeda0 ebejoyouy}o Al!ledlolunIN ay1 NOiinvO Ieuo11!puoo ale leas s,a9aulbu3 P' ...... . " y o9LL'3J NOSdV3dd A `X�?1.V.�YV L d ;rvw6a 6 t/ oxr 444 Ienoiddy Ieuoll!puo0 }o swaal panoaddes10 panoaddy Aq swooapaq ao} panoaddy IVAOaddV SHHd '9 TI -9 a}e0 sseippy LL966 xy ` zanTg aT2PH -l-SPH Mazn4sa.zD 19FOT auoydale i wall ;o MEN— OOLt-969 outaaauTDug uieq"unoN 'uolloadsul slyl }o alep ayl uo loolle ul suoheln6ad pue 'seoueulp.)o 'sepoo alelS pue ledlolunN Ile yl)nn aouelldwoo uI sl walsAs lesodslp aalemelsem ao/pue Alddns aalenn ails-uo ayl 'uolloadsul pue uollebllsanul Aw woa; pue Sall} abejoyouy }o Al!IedlolunIN ayl woa} paulelgo uollewaolul ayj uo paseq` leyl A}IJan a9yl1n} I `ulaaay.paleolpul aanlonals;o E) pue swooapeq;o jagwnu ayl ao; alenbape pue Ieuolloun; ales sI welsAs lesodslp aa}emelsem ao/pue,Alddns aalem ails-uo ay; 1gy1 SM0gS Ienaddy Allaoylny. ylleaH" slyl }o uolle6llsanul Auiley}A}I]an I 'Molaq umoys alep uollepllen ayl}o se pue olaaay pail}}e Zeas Aw Aq pal;llaao sy "NOI1dWHwNI ONV t/1d0'HOMS 3-1Id `S1S31 `SNOLLOUSNI ONIOIAOlid Wkiid JNId33Nl!DN3 '9 MSN\G\M�'os �Rv G�,C� .11 01 \)-V A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) ih Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 Legal Description: RABB]. l URE11,JC Ell?Iiall'I',� LOT 3, BLOCK b -- Well Classification IRESIDFNITFI A1' Well Log Present (Y/N) YLf> . Date Completed 11/83,F_ If A, B, C, D.E.C. Approved (Y/N) N/A Yield ' `E QPM Total Depth .t 1.` I *Cased to1_iNK. Depth of Grouting I)NKNOWN Static Water Level 1- 2 Casing Height Above Ground -' Electrical Wiring in Conduit (Y/N) Y1' SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot . > l OU To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line N/A. Pump Set At UNKNOWN Sanitary Seal on Casing (Y/N) YL' Depression Around Wellhead (Y/N) NO On Adjoining Lots' -I 00' N/A ; On Adjoining Lots >1.U()' To Nearest Public Sewer Cleanout/Manhole N/A To Nearest Sewer Service Line on Lot > 15 Water Sample Collected by Mountain iJ,nN;i.riec .r=i.n�', ; Date 4/(I A Water Sample Test Results PASSED - C;OI_,:IDORM & IdITRATJ' 11 Comments -1:P1t;R W110L1, LOU 11./C83 B. ZZI TIVH®LDING TANK DATA Date Installed 5/? U90 Size , 000 No. of Compartments 1 Standpipes (Y/N) YEB -Air-tight Caps (Y/N) YES Foundation Cleanout (Y/N) NO Depression over Tank (Y/N) NO Date Last Pumped Pumping/Maintenance Contact on File (Y/N) N/A ; for Holding Tank High -Water Alarm (Y/N) Y Temporary Holding Tank Permit (Y/N) N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well > II10' To Property I-ine > O' To Water Main/Service Line >20' To Building Foundation > 1 5' To Disposal Field To Stream, Pond, Lake or Major Drainage Course _N/A Comments ION - ;11:Y TN:;I=RC I'I ON PRPORT 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absortion Area Type of System Design Length of Field Depth of Field Gravel Bed Thickness 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 Statndpipes Present (Y/N) Date of Last Adequacy Test To Property Line On Adjoining Lots To Stream, Pond, Lake, or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments To Existing or Abandoned System on To Cutback (if present) Dimensions Manhole/Access (Y/N) "Pump Off" Level at Vent(Y/N) Pumping Cycles during Adequacy Test, "Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and HAAuidel4QOffect on the date of this g �,e„ 4 inspection. ;lop Signed to,. Company'• �,,ngineer's Seal Date �T.O MOA No. CI ill- s 14 - Receipt No. � U-LaSS Date of Payment Amount: $� �� c MARK W. PFARSON f c` �> CE - 7760 \ �N Receipt No. Aar Waiver Fee: $ Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 R STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562.2343 \ FEDERAL TAX ID N 92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 20921 Date Report Printed: APR 10 90 @ 08:21 Client Sample ID:L3, B15; RABBIT CREEK HTS Client Name MOUNTAIN ENGINEERING PWSID :UA Client Acct MTNENGN Collected APR 6 90 @ 11:40 hrs. P.O.# NONE RECEIVED Received APR 6 90 @ 12:30 hts. Req # Preserved with :AS REQUIRED Ordered By Analysis Completed :APR 6 90 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)MOUNTAIN ENGINEERING Released By G �t� 2) Special HOLD FOR PICK-UP Instruct: Chemlab Ref #: 900779 Lab Smpl ID: 1 Matrix: WATER Allowable Parameter Tested Result Unite Method Limits ---------------------------------------------------------------------------------------------------------------- NITRATE-N ND(0.10) mq/l EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY LOCKYER. 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than OF.,NOFDFNp , CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 1160 RATORIE6 5633 B STREET •ANCHORAGE, ALASKA 99518 • TELEPHONE (907) 562-2343 FEDERAL TAX I.D. #92-0040440 ANALYSIS REPORT BY SAMPLE for Work Order # 26701 Date Report Printed: AUG 28 90 @ 15:59 Client Sample ID:L3 B5 RABBIT CREEK HEIGHTS 8127 BYRON Client Name MOUNTAIN ENGINEERING PWSID :UA Client Acct MTNENGN Collected AUG 24 90 @ 12:55 his. P.O.# NONE RECEIVED Received AUG 24 90 @ 13:30 hrs. Req # Preserved with :AS REQUIRED Ordered By : MTN ENGINEERING Analysis Completed :AUG 27 90 Send Reports to: Laboratory Supervisor :STEPHEN C. EDE 1)MOUNTAIN ENGINEERING Released By 2) —=...... —=e=._.........s ........... ........ _........ ..a.===. Special Instruct: Chemlab Ref #: 903226 Lab Smpl ID: 1 Parameter Tested ---------------------------------------- -------------- NITRATE-N Sample ROUTINE SAMPLE, Remarks: SAMPLE COLLECTED BY LOCKYER. Matrix: WATER Allowable Result Units Method Limits --------------------------------------------------------- ND(0.10) mg/1 EPA 353.2 10 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION AUG 2 91990 RECEIVED = 1 yS2L y Tests Performed e aQoo `v'See Special Instructions Above UA=Unavailable ND- None Detected See Sample Remarks Above NA= Not Analyzed LT -Less Than, GT -Greater Than MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONIENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include lot, block, subdivision, section, township, range) �,e.�.�,•-`5' I:�.L.C.(=l��.d�.....�s'���f`..�....�:A`.:1��'.��.1.a�...m..'S�`_.__��-��������1:1_�:N6( Location (address or directions) 1= �, ri) TU „-A) [� p= �.:: ;'! [L9 %3 Yi2c7nl.� / r iiJ '!' /' / �,. Cf�'� `� 'C __ (b) Applicants Name ���cr-a:_�/, �/!�ther-r�_ele�hone _ 13omet� J4�� Dusiness Applicants Address d-) />1 AiK (c) Applicant rris (check one) Lending Institution ��� ; Owner/builder 1.7r; Buyer C�1 ; Other [ (explain); (d) Lending Institution __. Telephone Address (e) Real Estate Co. & Agent Address Telephone (f.) Mail. the HAA to the following address: 2. Tye of Residence Single-family Number of Bedrooms 3. ilip2iy- Individual.dual. Well Er --'1 Multi -Family Community E__I Other (describe Public ED 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 l --•Z PublicCommunity Holding Tank E___1 Note: If community well system, must have written confirmation from the State Denartment of Environmental Conservation attesting -to the legality and status. (Page 1 of 21 F2 G Engineering Firm Providin In cti�on:s, 7'osts File Searchi 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 indI.cated 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 regula- tions in effect on the date of this inspection. d . c /AJC Telephone 3`IC. j j Name of Firm d�c .� L A6/N i �-a _ � �7. dry_,. Address -/1_�_`_�_ Date—EL (ENGINEER SEAL) DHEP_ Approval Approved for 9, ` bedrooms By Approved Disapproved Terms of Conditional Approval rJy �p `c f i/� oUy o0. 11 L 0100/(y0 d/.b 11,x, ri �}'��{� 1,04� Conditional CAUTION THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEAI.,TH AND ENVIRONt'4EN1'AL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA.. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE, IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEERS WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 IV alcipalit of nc 1a e MEMORANDUM r DATE: �.pL/e!•� i� �✓�% � /c To: FROM: SUBJECT /r Ate w elm/i 44; J�IfCG� Js'e2 ) OJ ire JiJo'//PsJe rytoiuo�,. c / ��/y •-� rrrc� �.r �e� yt O o- �, <�.f.Pi oc/�' c � /r9de/'1 //1 a 1 6� GNl--c`> Z40 riYJgliPo9/cl'w7 C• O'l-�Q-yy,l G�/7.Cy CJ/J'//��' D'! <t <?CG�cv 1 ej'A6 /lL v" J-y��J rc.�ii9 rP.1 J'CL 91-010 (4/76) .1s MUNICIPALI'T'Y OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTIOR MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) AUG 2 0 108 CHECKLIST FEBRUARY 1984 P E (" P: S \ / E D A. WELL DATA Legal Description: L07—,& 8uxk' `; — J��—._--- Well Classification L,LJD1ViDL)4t o I£ A, B. or C, D.E.C. Approved(Y/N) Well Log Present (Y/N) Yes Date Completed 1000r Yield� U cP.Lt Total Depth�l Cased to ►J 1 Depth of Grouting Static Water Lave1 A Ki LSi6A/ Pump Set At__. (j_ Casing Height Above Ground -4 / Sanitary Seal on Casing (YM) YE -.S Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (YM) �)p Separation Distances from Wall: To Septic/Holding Tank on Lot 0 r_ On Adjoining Lots > 20� _ To Nearest Edge of Absorption Field on Lot 100 On Adjoining Lots > 2_001 To Nearest Public Sewer Line !"1 To Nearest Public Sewer Cleanout/Manhole— A)ZA To Nearest Sewer Service Line on Lot N14 Water Sample Collected By Date_/&Ac) pzl —i Water Sample Test Results 5�'1 Comments B. B. SEPTIC/HOLDING TANK DATA Date Installed / L— Size /(TUU 61( t -No. of Ccmpartments _ 2— Standpipes Standpipes (Y ) Air -tight Caps (Y/N) `4EG Foundation Cleanout (Y/N) Depression over Tank (Y/N) &)D Date Last Pumped ti, •L1 Nim' Pumping/Maintenance Contract on File (Y/N) A,1 ,n for _ /V//'I —_ Holding Tank High -Water Alarm (Y/N) f Temporary Holding Tank Permit (Y/N) 1U.11-4. Separation Distances from Septic/Holding Tank: To Water -Supply 4 11�('x) To Building Foundation %S To Property Line. To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course �A --- —� Comments (Page 1 of. 21 k__ _.'2 0 _ePY 2-13-84 kkk ..LT;b�i(i;��aM�f�IifIf� I Soils Rating in Absorption Strata Type of System Design Date Installed i,5- f g zi Length of Field Z-1- �3 Width of Field 2,` Depth of Field 41 _ Gravel Bed Thickness 8 �` Square Feet of Absorption Area Standpipes Present (YIN) �,eL 3 Depression over Field (Y/N)ba to of Last Adequacy Test NIA Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply We11 / LOO F _ To Property Line To Building Foundation To Existing or Abandoned System on Lot N /,q , On Adjoining Lots _ ',-_ /foul To Water Main/Service Line IJ 114 _ To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course Al )A To Driveway, Parking Area, or Vehicle Storage Area <45-0/ Comments D. LIFT STATION Date Installed Size in Gallons AJo-i ,)PjOL1 c.4 i3LE "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Convents Dive ns ions Manhole/Access (Y/N) "Pump Off" Level at Vent (YM) Pumping Cycles during Adequacy Test. Meets MOA Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or confcrne d to all MOA HAA8Ww in effect on the date of this inspection. Signed i ' a- Date / 7XJU(z A°°o.((�n© `00� 0d��° ey COD ° * Company ENc-rnlcZ7ie_ c /,C/C. MOA No. OF 1d.�R5 ° ° KB1/d5/s HOMA5 - e ° e <., °, 2.248-f (Page 2 of 21 2-15-84 „I 1 hrr E. S�var�sor� a Rec�is�`��ed Ora ��Sf/o/1�/ Lard Sovey��” pursUa�f fo fh� /a Ws of fhe ffa fe of f/cqsAa, do herd y cer/ ify that the P ries shown described heredr7 yVe 'survey ro � a/1� ff1a1� h1!S draW%/ /S d Under my sapec'���/©� +t0F t��4'`9m . ,9 -� •. JOHN E. SWANSON- �br, LS -3152 ® a• , q �•.....•• `' j �®®pprofessianal�ti°♦41� ? I(/-?0,o4) prBZ�� /3/. i� 0 cji. M. - Field Measured Abe v✓�n eXlSft 4., loin ts� 0 / \ Fnd. 8 "t�e/aar B. 3 "5•, o� w Fns �nKefdr��. °67.66) CL=`1oOD)� %7 s 9. 6� 3 L 789•SI) L c < S' 788, 2 �R' _ v L r L� ReGa�/- 1 6/6 Fn .lofBovnclary Urve y 17'N. ig o. 5•'W, of �, L7- 5DfoSL TlN, R�n, snCREEK fI�IilBl f�DCff� FolV1711 904 Brass S Cap /x'017 �i9so) /oo Dafe• %�ZS� , % Comer- - .5�� . / 1 N89° 3S' Foarrd 91 Zlel Brass 2636./Z /cm. 396E