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Home My WebLink AboutFOX HILL BLK 1 LT 5Fox Hill Block 1 Lot 5 #051-073-23 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP141387 Tax Code Number: 05107323000 Work Type: Septic Upgrade Permit Effective Dates: September 26, 2014 to September 26, 2015 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: FOX HILL Site Legal Address: FOX HILL BILK 1 LT 5 G:1458 Owner/Address: CROSSEN KRISTINE J & YESNER DAVID R 21741 WOODCLIFF DR CHUGIAK AK 995675306 Site Mailing Address: 21741 WOODCLIFF DR, Chugiak Lot Size in Sq Ft: 43570 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field N Septic Tank N Holding Tank N 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 wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Received Issued By: Date: Date: Municipality of Anchorage Development Services Division On -Site Water and Wastewater Program mznt �, �l y r' n n N epartment **** VARIANCEIWAIVER REVIEW **** Waiver#: OSP141419 COSA#: _ Permit#: OSP141387 PID#:051-073-23 Legal Description: Fox Hill, Block 1. Lot 5 Engineer: PES Applicant: Kristine Crossen & David Yesner Your request for a waiver of the required 15 feet maximum bed width has been approved. The approved width is 20 feet. This waiver approval applies to the proposed Error! Reference source not found. only. ❑ The affected adjacent property owner(s) have been given a 7 day notice regarding this ❑ Notarized letter(s) of non -objection have been received from the owner(s) of the affected adjacent property. ® Adjacent properties are not affected by this waiver. .......................................................... 0.................... Waiver is Granted: X Waiver is not Granted: Date: 01 ° ® �cl Approved lo . Name of Reviewer ................... 0 ........................ Y..•............... a............... MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-073-23 Property owner(s) CROSSEN KRISTNE J& YESNER DAVID Day phone Mailina address 21741 WOODCLIFF DR, CHUGIAK, AK, 99567 Site address SAME Legal description (Sub'd., Block & Lot) FOX HILL BLOCK 1 LOT 5 Legal description (Township, Range & Section) Lot Size 43570 So. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Field ❑X Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑ Upgrade ❑X Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ C C E P T E (SF and/or D) Private Well ❑ A Per AMC 23.10.104.12.1 Water Storage ❑ SEP 8 Ak' THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: 91A, " Date of Payment: Receipt Number: Permit No. 0`Jp I�ilji8 i Permit App_.: 11 Waiver Fees: Date of Payment: a¢ 7 Receipt Number: C) 0A 0A %- Waiver No. 0-5p/ giq Pannone Engineering Service$ LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com September 19, 2014 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. O. Box 196650 Anchorage, Alaska 99519 Subject: Fox Hill Block 1 Lot 5 Septic System Permit Request Ladies and Gentlemen: I am writing to request a permit to install a new septic system be issued for this property. The proposed systems will serve a existing three (3) bedroom house. Currently the existing house is served by a conventional bed drain field . The proposed system will utilize the existing 1000g septic tank and a conventional drain field. The surrounding developed lots are served by private wells with the one to the west on city water from the west. There are no wells on surrounding lots within 100 feet of this system. Soils. We performed one test hole on this lot, and groundwater was monitored on 8/27/2014 and ground water was observed below the ground elevation in the test hole monitor tube at four feet. From 0.0' to 1.0' was organics, from 1.0-4.0 ' was a sand with gravel, and from 4.0' -9.0 silty gravel. It is my opinion, based on the results of the soils tests, the use of a conventional system and overall soils appearance; an application rate of 0.5 gallons/day/square feet should be used. 1. Soil Absorption System Design. a. See Sheet 2 of the design package. 2. Surface Water: There is no surface water within 100 feet of the proposed septic tank and drain field. The proposed drain field upgrade will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: The existing topography slopes from the east to west at approximately 5% in the area of the proposed drain field. There are no steep slopes located in the area of the proposed drain field. Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 4. Drawing Markings: The Drawings are marked "For MoA Review Only". When written notification that the review is complete and that there are no further comments is received from MoA On -Site Deip�r_tment, the note will be removed and "Issued for Construction" drawings will be issued. 5..a 4,rWaiv Request: Due to site conditions we request a waiver to the maximum bed width, to install a36�3fJsot b d system. We are also installing a ratchet valve to help with even distribution of effluent er and increase ongevity of the bed system. installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor Ave, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 Z- / / '-- SEPT C AREA 1, / EXISTING IG _ `� I // ��. WELL L --- _ / SEPTIC EXISTING AREP. OvELL i � y� Drpg ES / Ant LOT 6 i LCT D -ems = Per .9. PAT \ I DRIVE" ��—TH-1 � �EXSTING L BR' ELEE/ATED BED(P) _\ HOUSE C.S E.D.,+2'TD 20' LF X 45''N X — —" B-'—)l'JDARIES OF CO's/ER C EXISTING �I BED EXISTING 1060 GAL TANK (TG BE VERIFIED AT TIME OF CONSTRUCTION INSTALL LIFT STATION !P) ELL' LOT 4 i SEPTIC p i AREA (NOTE- THIS IS NOT A SURVEY AS BUIL�T�7�-CATION ON LOT APPRGXIVA-.E NOTES- PANNONE ENG SVC, LLCOF.q � Date I FOR CONSTRUCTION �� ....Lq�l�� 9/24/2014 P.O. BOX 100217 ANCHORAGE, AK 99510 S PHONE (907) 272-8218 FAX (907) 272-8211 ��p Fy+) scale FOX HILL % * * PI'D.07O BLOCK 1 LOT 5 /.. ...... .. ......../ -2 Steven R. Pannone / PERMIT NO. CROSSER KRI TINE J & YESNER DAVID R�PF�s. �. CE 8149-. �% oSP141387 217.1 WOODCLIFF DR _ Sheet PLAN CHUGIAK, AK 99567 �111�PROFE`S90W 1O 3 SPECIAL PROVISIONS TO SPECIFICATIONS 1, ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATEP. DISPOSAL SYSTEMS AND ATTACHED PES SPECIAL PROVISIONS_ 3_ SCOPE CF WORK: INSTALL NEW SOIL ABSORPTION SYSTEM & VERIFY INTEGRITY OF TANK. 4. GROUNDWATER WAS ENCOUNTERED FOUR FEET BELOA' EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 4 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMEDIATELY. PROVIDE NIINIMUS1 2OF COVEEF RIGID INI o DRAIN PII \ W, j' LAI£S.RW_ED 13 OC FILTER FABER. DRAIN EM ET .v ABOVE PIPE IN.ERi 3.0 1 0.5 HILL OLD I LH TPENCX SEE DESIvN RF.MGVE JRGONIC REPUTE WITH SAN( 1000 g SEPTIC TANK (E) PROFILE 4 �. ___— __. _. __ - _ ____.—__._--GFOUNDIATER Cu COPPER �n DIP DUCTILE IRON PIPE LEGEND SECTION DESIGN PARAMETERS ____ _ WATER LINE/ FC FOUNDATION CLEAN CUT RIFIO INSULATION—, _ WELL FADIUS 7,TANK CLEAN OUT NO, NO. BEDROOM. 3 (450& VP i1LTER laBRk_ \\\ C'F CLEAN OUT N0. TANK. S12E. 1000 G SOIL RATING. 0.5 CPD/'SF '— NEW SEPTIC Rl MONITOR TUBE N0. AREA RCD, 900 SF _ '0 - - oaav Reck s'.eavE vlaECS o MIN LENGTH: 50 LF 3 PwE DV DIVERTEP VALVE erT rs"xoDs oal`HEow Ie'NC TPENCX SEE DESIvN RF.MGVE JRGONIC REPUTE WITH SAN( 1000 g SEPTIC TANK (E) PROFILE AB BREv✓1f-.Tl V NS Cu COPPER DIP DUCTILE IRON PIPE LEGEND TH TEST HOLE DESIGN PARAMETERS ____ _ WATER LINE/ FC FOUNDATION CLEAN CUT UPGRADE SEPTIC SYSTEM _ WELL FADIUS 7,TANK CLEAN OUT NO, NO. BEDROOM. 3 (450& VP C'F CLEAN OUT N0. TANK. S12E. 1000 G SOIL RATING. 0.5 CPD/'SF '— NEW SEPTIC Rl MONITOR TUBE N0. AREA RCD, 900 SF RI. RIGID INSULATION SYS. TYPE- BED 0.5' E.D. DCO DOUBLE CLEAN OUT MIN LENGTH: 50 LF DV DIVERTEP VALVE FS PLOW SPLITTER USE: BFG BELC`N FINISH GRADE 20 LF X 45' WIDE, 0 E.D., +2.0' TD GG ORIGINAL GRADE TOTAL AREA. 900 SF FG FINISH GRADE TS&V TOPSOIL & VEGETATE NOTES. PANNONE ENG SVC, LLCF P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 a� ��i r'�P' % - ��"S'teve'n R' Pannone j Pte. CE 149 IPE- 5 � � q 24/Zo, 4 FOR CONSTRUCTION Scale I"=50 P.I.C. NO -5,-073-2'_ FOX HILL -�, BLOCK 1 LOT D CROSSEN KRISTINE J & YESNER DAVID R 21741 WOODCLIFF DRII PER uT No OSP141387 Sheet PLAN CHUGIAK, AK 99567 ,~ t FeoFEsS�' 2 OF 3 READING SOILS LOG - PERCOLATION TEST TEST HOLE 1 NET TIME TOPSOIL SLOPE V 2' i2 SITE PLAN 1 OR i 8-12-2014 221 I �� yi- 2 GRAVEL WI 3 Gplsm SILTY SANDS Ix TEST 10 MIN (HOLE , 4 / ` I 2:31 6 6.04 ' 4 7 GM Silty GRAVEL 241 10 MIN 7.10 t.D6 5 9 � BOH I I I DATE PERFORMED: 8-12-2014 WAS GROUND WATER SLOPE 10 MIN ENCOUNTERED? Y tD8 IF YES, AT WHAT TH 1 DEPTH? -8.0' X I DEPTH TO WATER AFTER MONITORING? -4.0' DATE: B-27-14 WATER PEROLATION RATE 10 (min/inch) PERC HOLE DIAMETER 6 inches TEST RUN BETWEEN 2 FT AND 3 FT COMMENTS: Test hole excavated by PANNONE ENGINEERING SERVICES. Prec hole was presoaked. Last 3 readinrecorded. gs PERFORMED BY: Steven R. Pannone, P. E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDLINES IN EFFECT ON THE DATE OF THIS TEST. NOTES PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 ='oF a� ��i J �� q �� /mit 49 TH *�� Date G14 FOR CONSTRUCTION Scale NTS �... .... I PLID NO FOX HILL �' (" ;-— 7.. f_."e.vIen 51-073-2 CROSSEN BLOCK 1 LOT 5 �R S�TIN�OODCL YESNER DR DAVID R Steven Pan ��R. none � . �CE �9 �� F,o �...'� PERMIT NO. OSP141387 Sheet SOILS LOG CHUGIAKAK 99567 �l�� o S% , 3 OF 3 READING DATE CLOCK TIME NET TIME LEVEL READING NET DROP ' 1 i 8-12-2014 221 62] � t 2 231 10 MIN 6.94 1.6] i 3 I 2:31 6.04 ' 4 ( 241 10 MIN 7.10 t.D6 5 241 5.96 6 � � 2:51 10 MIN 7.04 tD8 �— MUNICIPALITY OF ANCHORAGE �® DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska, 99501 Telephone 264.4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE NEW 1 ftLP I'� LS. �'- L) ( t'�Mf�-I�-� •� C[�II ❑ UPGRADE MAIL] NG ADDRESS Cj CC��+••ii q/•J/� 11( },7/♦�LL'' //!/ / /s/ /{/J L 1�� -` � �Yv Vf � �=.%� /✓Vr F7 '��7F✓ / G/ n � l✓-C'.�/�� /\��t�� / /�/�-1 �'�/ / LEGAL DESCRIPTION ' LOCATION NO. OF BEDROOMS Well Absorption area Dwelling PERMIT N0. 6 L10,16 -) Z Manufacturer // Material S7•l No, of compartments w I.Q.. .�- w Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth �e 9 (7 z DISTANCE TO: Well Dwelling PERMIT NO. z Manufacturer Material Liquid capacity in gallons -rx LU DISTANCETO: Well Foundation Nearest lot line PERMIT NO. J LL z Z No. of lines Length of each line Total lend o li s Trench width Distance between lines w l- / inches �cc F- To of tile to finish rade P 9 Materia benea the Total effective absorption area! ❑ inches w Q Length/ i Width /,.% / Depth r.� > PERMIT NO. �j�� / `� Q N w Lu Type of crib Crib diameter Crib epth _ Total effective absorption area �/ 1Y DISTANCE TO: Well {� ,� Ov ding foundation!earest lot line •y- yAy-- /0 Class De h Driller Distance to lot line PERMIT NO. LU DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER - PIPE MATERIALS SOIL TEST RATING / r' 4) V - INSTALLER -�/�" RE=MARKS 9 �n I �,. OF ,q(,�1►i1 v��• ��' I JAI/ 0-1 i sit r u n•• •. r� Ubart A, Isfafor ry `R APPROVED �� DATE �j SRti 194? (b � lrlVMf�r Aif,Sfr... .. I t��. �i9q asa:a r WGZM raus�u.11R yff[ai A� A A., FqC F RIVER, P�NS�P HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOIL TEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN July 20, 1986 Mun,icipaP ty o4 Anchorage Department ob Hea th and Human SelLviceb 825 L Street Anchorage, Ataska 99501 ATTENTION: Susan 06watt REFERENCE: Lot 5; Bock 1; Foxh.iU Subdiv.i,sion ROBERT A. SHAFER CIVIL ENGINEER 694-2979 MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION JUL RECEIVED An on-site wastewater disposak 6ystem was .instaUed on the ne4eneneed property under permit #840100 on July 31, 1984. Inspection/, were performed and ane documented on an inspection report on bite .in our o66ice. This report has not been submitted bo4 record due to non-payment ob bees assoe iated_,w.ith the wadi. MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & eR%AFER�,P. E. ENVIRONMENTAL PROTECTION /as klUL 21 1986 RECEIVED SRB 196X EAGLE RIVER, ALASKA 99577 PERMIT NO� DHTE ISSUED F1PPLICAM' HDDRES�� LE�H� DESCRIP LOT SIZE: LOT LOCHTION NHX REDROOi1S HS So 1: ul; 1: ITO H"s L. 1 -1- "VP 13 to" So H 41 KTT 0111 IC�)l 1114'.,.'! IC -'ii F:::�, DEPRRTMENT OF HEHLTH HAD ENVIRONMNTHL PPOTECTION 825 L STREET, HNCHORHGE/ F-1 1;:: 9S.-I5I-D1 264~4720 14 K It: to HA Q R.. k- IF FR :1 -"1 840100 0]/29/84 Cl S & S ENG'GSCHUCHMHN SRB 195X EHGLE RIVER, HK 99577 694~2979 SUBDI-� SECTI0N: 4 TOWNSHIP: 15N 4000i (SQFTOR HCRE�) WOODCLIFF DOFF GLHCIER RD ] LOT5 BLOC1 1 RHNGE� 1W LISTED SYST�M BELOW HRE THE CHOOSE THE OPTIONS OPTION THHT HVHI1 ...H8LE TO YOU IN DESIGNING YOUR SEPTIC BEST F., ITE YOUR SITE, � � � � ~ ^ ~ � � �°� ~ ~ _ � ~ ~ ~ _ _ _ � ~ _ � � li IC.:"�� DEPTH TO PIPE BOTTOM (FT. ) 4.0 A3 4.0 GRH 4.0 05 I5 TOTHL DEPTH (FT 8.0 0 75 GRHVEL WIDTH (FT > 2.5 240 50 GRHVEL LENGTH (F 108.0 ** 470 9]0 ** GRHVEL/VOLUME (CUYDS ) 450 417 688 THNK SIZE (GHLS) 1/ 0 ** 1/000.0 ** 1,000.0 ** S�IL �HTING (SQFT"/BR) 287 250 287 ** GRHVEL L�NGTH } 75 FT REQUIRES MULTIPLE RUNS (NOT EHCH) ** ..~��..�-~~~.~.~��..~~~��-..~��~~~.~��~~� THNK MUST HRVE HT LEHST TWO COMPHRTMENTS I CERTIFY J- THHT� I HM FHMILIAR WITH THE H.H. SEWERS HND WELLS AS:,; SET FORTH BY THE MUNICI PAL ITY OF HNCHORHCE (MOH) HND THE STHTE OF HLHSKH. 2 I WILL INSTRLL THE SYSTEM IN HCCORDHNCE WITH ALL MOH HND REGULHTIONS/ HND IN COMPLIHNCE WITH THE DESIGN OF THIS PERMIT. ] I WILL HDHERE TO F1 I.- MOH HN� STHTE OF HLHSKH R�QUIREMENTS FOR THE ��T BHCK DISTHNCES FROM HNY EXISTING 1 dELL, WHSTEWHTER DISPOSAL OR PUBLIC SEWERHGE SYSTEM ON THIS OR HNY OR LOT. 4 I UNDERSTHND THHT THIS PERMIT IS VHLID FOR H MHXIMUM OF ] BEDROOMS AND �@Y ENLHRGEMENT WIL1 HDDITIOP.-IHL PERMIT. IF H LIFT STHTION IS INSTHLLED IN HN AREA COVERED BY MOH BUILDING CODES/ THEN (1) HN ELECTRICHL PERMIT AND INSPECTION MUST BE OBTHDNED/ (2) HS~BUILTS WILL NOT BE HPPROVED WITHOUT HN ELECTRICRL INSPECTION REPORT/ HND (]) THE ELECTRICHL WORK MUST BE DONE BY H LICENSED ELECT[;�:ICIHN. SI6NED DHTE� �� HPPLICAM C/O S/=% S ^�It! 'G. SCHCHM.7 ISSUED BY DRTE ~~�� vn/-_~_... n n t' ) D li ..'1,(I`JIS( ), irxill. 1[I."V i.\1')\ f{1,6 m £)�(__ PUuGH C, G50 ANCIAl (9Ui 120; + I I 1 DEPA'I FfAF.N-f OF 11F ALT Ii AFID FNVIFIONIVICN IAI_ KtO-MCI ON Permit 11r: 840100 January 31, 1985 TO: Permit Applicant SUBJECT: Lot 5 Block 1 Foxhill Subdivision A permit issued by this Department for an individual well and/or on-site sewer system has expired as of December 31, 1984. Permits are issued on a calendar year basis by authority of Municipal Ordinance. A new permit must be obtained from this Department for any well and/or on-site sewer system not installed by the expiration date. If you have drilled the well, a well log needs to be sent to this Department for documentation of the installation and to close the permit. If a private engineer inspected the installation of the on-site sewer system, the original as-bui_lt inspection report and the yellow copy must be sent to this office for review and approval, and for documentation. If there are any further questions, please call. this office at 264-4720. Sincerely, Keith E. Berndt Supe visor p Environmental Engineering Program KEB/ljw enc: Copy of Permit SWP/057 ❑ SOILS LOG MUNICIPALITY OF ANCHORAGE 8L6 -Cl ( 0O DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ❑ PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 \' SOILS LOG - PERCOLATION TEST - - PERFORMED FOR:grLr"ll� � � DATE PERFORMED: LEGAL DESCRIPTION: Z gE�PTH SLOPE SITE PLAN 1 j d G- 2— ,v 3 4 6 b 7 8 /c 9 v 10 11 12 r� 13 14� � 0 15 �y 16 17 81920 18- 19- 20 COMMENTS 2 C/ V �1 WAS GROUND WA)ER - ENCOUNTERED? IF YES, AT WHAT DEPTH? 'Reading Date /V/ %off//uG- e S L O P E .[ Gross Time Net Time Depth to Water Net Drop — I -174v, fl ilv f of 2. _ /o 3 lii/4E/o_lt PERCOLATION RATE-.,(minutes/inch) TEST RUN BETWEEN `-� — FT AND -- FT PERFORMED BY:y CERTIFIED / _ DAT B3::/y_:20G 79-008 f6/791 DOC Co. dba SULLIVAN WATER WELLS P.O. BO%272, CHUG IAK, ALASKA 99567 • TELEPHONE 688-2759 OWNER OF LAND -,J �N✓ CN/Y1A'"� �■"�5- ADDRESS /02"7__—_ -- LEGAL DESCRIPTION DATE - Started Ended - PERMIT NUMBER NUMBER KIND OF FORMATION DEPTH OF WELL _? _7 -- STATIC LEVEL OF WATER FT. -15�11 _ DRAW DOWN FT. GALS, PER HR C74 00 KIND OF CASING —6 1 C.)/ — From 9 Ft. to 3 Ft. -&J— �� ✓R/./c _—_ From- --Ft. to --Ft- From- __Ft. to-s5'_—Ft. � s F"Kff✓tFG From -_--Ft, to ---Ft.- Ft. From_ --- Ft. to_Ft.- From Ft. to4Y57- $:� From 85- to-1-LOO Ft. a � t �Q� �� -- From -Ft. to Ft - //A Ft. to %/y Ft. — From-_-------Ft. to-_ -Ft_From From ---Ft. to Ft. �G.4 r �-, 111_ From -_ Ft. to- ---Ft. l From -!/y Ft. to Ft. s From --Ft. to Ft. From ---Ft. to Ft. A r6lZ _ From ----Ft. to ---Ft. From_ Ft. to Ft. From Ft. to --Ft. From Ft. to Ft. _ From Ft. to. _Ft. From ---Ft. to Ft. From--__ Ft. to- Ft. From --Ft. to Ft. From___Ft. to—Ft. Froin Ft. to Ft. From Ft. to Ft From_Ft. to Ft. From Ft. to Ft. From --Ft. to ---Ft. - -- MUNICIr, -RAGE From_ _-Ft. to.—Ft. ENVIRON, o. Ft.ENVIRON, -ON From _Ft. to_. Ft. From _Ft. to_ Ft. f�('T i S� 10no From Ft. to Ft. From. Ft. to_ Ftp t\1-��T— MISCL.INFORMATION: DRILLER'S NAME--- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH \� CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL \1 OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date September 26, 186 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) _ r_nt 5_ _B]1 o 1 ; Fnxh i 1 1 Suhr]i ��i Ginn _ _ Location (address or directions) (b) Applicant Name Telephone: Home --_ -- Business—78i&36_4__ Applicant Address _ rinjrtecL_ an of Al ant aska__ (c) Applicant is (check one): Lending Institution) ; Owner/builder ; Buyer Other f7 (explain); (d) Lending Institution _upped_Banjr._ f___Aj j&ka__Telephone Aga -6 64 _ Address 440 East. 36th Avenue, Anchorage, Alaska_ 99503 (e) Real Estate Company and Agent _ none _ Address Telephone (f) U4D the HAA to the following address: S & S Engineering M 99577 2. TYPE OF RESIDENCE Single -Family RI M/i=Famil ❑ Other Number of Bedrooms 3 3. WATER SUPPLY Individual WelKUr. Community ® Public n 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 RCI Public 0 Community C] Holding Tank Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DA i A 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 4&—Tele hone Address �6% — Date .:" GLE RIVER, AK 9957 _ ,,/0 / ZZ3, liq � 6. DHEP APPROV L Approved for bedrooms by Date Approved Disapproved—Condition`a1n"� Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) Pr.rl. Vr MALIN 6, ENVIRONMENTAL PROTECTION MUNICIPALITY OF ANCHORAGE (MOA) OCT 13 HEALTH AUTHORITY APPROVAL (MAA) CHECKLIST - FEBRUARY 1984 RECEIVED 264-4720 / Legal Description: S^ 61 S Y TJ_6J_ A. WELL DATA Well Classification le If A, B, C, D.E.C. Approved (Y/N)Well Log Present (/ ) Date Completed — Yield C s O -S_1 hvr Total Depth % Z Cased to 2 Depth of Grouting N — Static Water Level r — Pump Set At rr Casing Height Above Ground 2 y f Sanitary Seal on Casing (Y N) Electrical Wiring in Condui (Y N) Depression Around Wellhead Separation Distances from Well: r To Septic/HTank on Lot On Adjoining Lots L� To Nearest Edge of Absorption Field on L t_ ; On Adjoining Lots To Nearest Public Sewer Line _ N h To Nearest Public Sewer �� Cleanout/Manhole N To Nearest Sewer Service Line on Lot — Water Sample Collected by S '� ��lheu4 1 ; Date Water Sample Test Results Comments 2 S_ r t� B. SEPTIC/HOLDING TANK DATA Date Installed 3)LEW Size ��l%C� No. of Compartments i Standpipe(Y N) Air -tight Cap (Y N) Foundation Cleanout (Y N) i. Depression over Tank (Y/Vb Date Last Pumped /Llo oCGGf �� Pumping/Maintenance Contract on File (Y/N) f /-} ; for Holding Tank High -Water Alarm (Y/N) P A Temporary Holding Tank Permit (Y/N)_ Separation Distances from Septic/1•Tank: r To Water -Supply Well �l% -/- To Property Line _ 10 74 To Water Main/Service Line `b Course Comments _ Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field /VV Ali- To Stream, Pond, Lake, or Major Drainage � �� >< Y/• � � (I 2 �� d V2 � d C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2 -SZ Type of System Design L5e- i age Age Date Installed 7 Z3 Len th of Field Z-/ /7 ' Width of Field Square Feet of Absorption Area Depression over Field (YN) — Results of Last Adequacy Test Depth of Field / / G Gravel Bed Thickness C� Standpipes Presen (Y)N) Date of Last Adequacy Test I U — (e ` 6(o Fez 3 S57. Separation Distance from Absorption Field: to To Water -Supply Well Z/iU -A To Property Line L� ' _ r To Building Foundation /a To Existing or Abandoned System on Lot A/o N E ; On Adjoining Lots -_70 14 r To Water /Service Line /d f To Cutbank (if present) �t To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area S[J 1— Comments D. LIFT STATION Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level atPu "�Qjff" "Level at High Water Alarm Level at i x/ent (Y/N) Tested for Electrical Codes (Y/N) Comments "` Check Permitted Bedroom Rating Against HAA Request " Pumping Cycles during Adequacy Test, Meets MOA I certify that I ed verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. C114V Signed EERING 3 Date / Company MOA No. 3 oft'0p •.» •.a 4 �'3y Receipt No ?00/ 00/�,'0 ��Q;. o, 5 Date of Payment ZOZ/�P� 2, % // 3°. • c. i • ti Amount: $ LOQ Page 2 of 2 72-026 (11/84)