HomeMy WebLinkAboutFOX HILL BLK 3 LT 4Fox Hill
Block 3
Lot 4
#05! -073-05
NAME
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENI'AL ENGINEERING DIVISION
82.5 L Street- Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
MAILING ADDRESS
LEGAL D N
LOCATION
I Well Absorption area I Dwelling
DISTANCE TO:
Manufacture
Liq, capacity in gallons
IF HOMEMADE:
Well
DISTANCE TO:
Manufacturer
No. oflines of eacbline tK.J~y~a, llengtb of lines
Top of tire to finisb grade 7I-~'~i b~enea~h ti~e
Le ng~ ~
Typeofcrib Crib diameter ~ Crib depth
Well
DISTANCE TO: ~, ~
Material
Width
Material
Nearest lot line
NO, OF BEDROOMS
Class
DISTANCE TO:
OTHER
PERMIT NO,
NO, of compartments~,..
Liquid depth
Building foundation
PERMIT NO.
Liquid capacity in gallons
PERMIT NO,
Trench width Distance between lines
inches
Total effective absorption area
PERMIT NO.
Total effectiveabsol~o~l. ~ ~[ea'i~L~
8uiiding foundation Nearest lot line
Distance to lot line
line Septic tank
PIPE MATERIALS
SOIL TEST RATING ,
INSTALLER
REMARKS
LEGAL
PERMIT NO.
[Absorption area{s)
DE'.'F'AR'i"MEIqT OF HIEAL1~H AIqD IENV]:ROIqMENTAI., F'I:i~OI'ECTIOI'~I
825 L S'TREET.~ ANCHORAGE., AK 9950];
2.6z1.'-472()
F:'ERM I'T' NO:
DATE ISSLIED:
840524.
Ar'PI_ I CANT:
ADDRESi-]:
CONTACT PHONE:
C/O S &. S ENG'G. SCHU[',HMAN CONSTIR.
EiRB 196X
EAGLE IRIVEF;I~, AK..'. 99577
694-2979
L.EGAL DESCRIF':
LOT SIZE."
'MAX BI'-_-DF~OOMS:
SUBDIVISION: FOX HILL
SE[]TION: 4 TOWNSHI F':
451:38 (SQ,FT. OR A(]RES)
3
LOT: 4 BLOCK: 3
;[Shl RANGE: :I.W
Listed be].ow ape the option.~ ava,ilable to you in designing yom' ~-~epti~
system. Chaose the op'/ion that best ~i'Ls yom" site.
DEF:'TH TO F:']:PE B(]TTOM (F"T.
· GRAVEL. DEPTH (F"T.)
T'OTAI_ DEF'TI'I (F"F.)
GRAVEL, W]]DI'H (FT.)
~3RAVEL LEIqG'I'H (FT.)
GRAVEl,., VOL[JME ((XJ. YDS. )
TANK SIZE (GALS)
SOIL. RATIN['] (SC,!. F:I',, /BR)
'T IF,~: IEEE I",1t C] tl-.-~t [~ lID] :ED, b~.tl ~ :E~ F~'. ~ ][ II'"dl
4.0 4.0 4.0
4.0 0.5 :3. ',5
8.0 4.5 7.,5
~. 5 14 ,, 0 5.0
32.0 2. F3 ,, 0 2.8 ,, 0
1 ~ 000.0 ** ]. ~ 000,, 0 ,~..~. :1., 000,, 0 *'~-
85 85 85
TANK MLII!~'I" HAVE AT LEAST TWO COMPAIRTMENTS
].. I am fami].iaP w:Lth 'Lhe requirements for' on-site sewers and wells a.s set
for'tl"~ by the Municipality of Anchopage (MOA) arid 'Line State of Alaska.
2,, I wi],], instal], the system in ai:coPdarice with all MOA codes: and Pegiilations,
and in compliance with the design cPiteria of this pePmit.
3,, I will, adhere to ali. MOA and State of Atasl.::a r'equiPemants fop the !se'L
distances fPom any existing w~ll~ wastewatep disposal system oP public
sewe~page system on th:i.!~ oP ally adjacent oP neaPby lot.
4. t urlders'kand that this pepmi, t is valid fop a maximum of :3 badrooms and
any enlapgement will pequiPe an additional per, mit,
IF A I...IF'I" STATION IS INSTALl-ED IN AN AREA COVERILZD BY MOA BUII..I)ING CE]DES,
THEN (1) AN EL.EETRIOAL PERMIT AND INSPECTION MUST BE OB'FAINED; (2) AS-GUILTS
WILL NOT BE APFNROVED WITHOUT AN ELECTRICAL INSPECT]i[)N F~EPOF~'.T; AND (Z.'3) THE
EL.E:CTRICAL WORK MU~iT BE DONE BY A LICENSE[D EL. ECTRICIAN.
S I GNED
APPL I C AI',IT:
ISSUED BY
'~~'~""C-'S/='""'~'-~44'~'~'-)'C/0 E.~' &' Iii' EIqEi' G ,, ~E',IaLJCHMAI~ CON~TI:t Y -- DATE."
~ ~~ DATE:
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
82.5 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
~ SOILS LOG
.>¢
[] PERCOLATION
TEST
PERFORMED FOR:
DATE PERFORMED: ~ '-,-)-,.~'-~/ (~__
LEGAL DESCRIPTION:
1
2
3
4
7
SLOPE
SITE PLAN
lO
11
WAS GROUND WATER
ENCOUNTERED?
12
13
IF YES, ATWHAT
DEPTH?
O
P
E
14-
15
16
17
18
19
2O
COMMENTS
PE'RFORMED BY:
72-008 (6/79)
Reading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE ,~ ~//Y~' (minutes/inch)
TEST RUN BETWEEN FT AND FT
Municipality of AnChorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 051-073-05
COSA#
GENERAL INFORMATION
Complete legal description FOX HILL LOT 4, BLOCK 3,
Location (site address) 22235 WOODCLIFF COURT, CHUGIAK~ AK 99567
Current Property owner(s) RICHARD & CHANDRA POSTMA Day phone
Mailing address
PO BOX 671370, CHUGIAK, AK 99567
Lending agency
Day phone
Mailing address
Real Estate Agent
LES BAILEY & ASSOC.
Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
NUMBER OF BEDROOMS: 3
TYPE OF WATER SUPPLY:
Individual Well
Individual Water Storage
Community Class ___ Well
Public Water System
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site []
[] Individual Holding Tank BI
[] community On-site []
[] Public Sewer E~]
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 ARCTERRA CONSULTING, INC. Phone 868-3792
Address 20441 PTARMIGAN BLVD., EAGLE RIVER, AK 99577
Engineer's Printed Name KENNETH M. DUFFUS Date 04/26/2011
Engineer's Comments: This investigation was completed in compliance with ADEC and MOA regulations. The
assessment of the condition of the well and septic applies only to the conditions as of the day tested. The flow
and absorption rates may change due to subsurface conditions that may not be observed from the surface,
changes inland use, local soil characteristics, groundwater levels that may fluctuate dudng the year and the
water usage of the family being served by the system. The operational life of all well and septic systems are
subject to these various and dynamic characteristics and are outside the control of the
evaluator of.the well and septic system. Therefore,
ArcTerra can not give any estimate of how long a
system will function satisfactory for current or future
occupants or can ArcTerra guarantee that no unseen
encroachments, deficiencies or discrepancies exist.
DSD SIGNATURE
Approved for ~
Disapproved.
Conditional approval for
bedrooms.
bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
........... -(R~{/F'i1705) j
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Repod
Other
Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: FOX HILL LOT 4, BLOCK 3
A. WELL DATA
Well type PRIVATE IfA, B, or C provide PWSID # __
Well Log (Y/N) Y
Date completed 9/1984 Sanitary seal
Total depth 142 fl. Cased to
FROM WELL LOG
Date of test 9/1984
Static water level 97 f.
Well production 50 g.p.m. 5.6+
(Y/N) x
40+ ft.
WATER SAMPLE RESULTS:
Wires properly protected (Y/N) Y
Casing height (above ground) 24+ in.
AT INSPECTION
4/19/2011
104 ft.
g.p.m.
Date installed 7/1984 Soil rating (g.p.d./ft~ or ft2/bdrm) 85 System type BED
Length 28 ft. Width 15 ft. ' Gravel below pipe 0.5 (0~0:~)* ft. Total depth 5_ ft. (Measured 4119/11)
E". absorption a~reaC~ft~ Monitoring tube Z Depression over field N
Date of adequacy test 4/19/11
Fluid depth in absorption field before test 4.8 in. Water added 450 gal. New depth __
Elapsed Time: 1440 min. Final fluid depth 3 in. Absorption rate >= 450. g.p.d.
Any rejuvenation treatment (past 12 mo.) (YIN & type) N__lf yes, give date--__c-
Results (Pass/Fail) Pass For 3 bedrooms
7.2 in.
C. ABSORPTION FIELD DATA
Tank Type/Material Septic/Steel Date installed 7/1984 Tank size 1000 gal.
Number of Compartments _2 Cleanouts (Y/N) ~ Foundation cleanout (Y/N) ~ Depression over tank (Y/N) __N
High water alarm (Y/N) N Date of pumping 4/19/11 Pumper IRs
Parcel ID: 051-073-05
Coliform NEC colonies/100mL Nitrate 2.21 mg/L
Arsenic:' ND mg/I Date of sample: 4/19/2011 Collected by: ArcTerra
B. SEPTIC/HOLDING TANK DATA
LIFT STATION
Date installed
"Pump on" level at __
Datum
Size in gallons
"Pump off" level at __
Cycles tested
in.
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot ;leo0+
Absorption field on lot :1000+
Public sewer main ?$'+
Sewer/septic service line 25'+
Animal containment areas 50°+
in.
Manhole/Access (Y/N).
High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots
On adjacent lots ;lee'+
Public sewer manhole/cleanout ;1000+
Holding tank
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+
Water main 100+
10(Y+
Property line 5'+
Water service line 100+
Absorption field 5'+
Surface water ;10(Y+
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line ;10'+ Building foundation ;100+ Water main ;100+
Water Service line ;lO'+ Surface water
Curtain drain 50'+ (None Knewn)
COMMENTS
10(Y+
Driveway, parking/vehicle storage ;10'+
Wells on adjacent lob ]aY+
*Measurements taken from bottom of post tank lateral and monitoring tubes show
effective depth below lateral. System is operating in top portion of effective depth.
appeared in the lateral or backed into the S.T. during the test.
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name
Date 4/26/2011
KENNETH M. DUFFUS
8.Z8-9.7Z'
No water
COSA Fee $490.00
Date of Payment
Receipt Number
(Rev, 11/05)
Waiver Fee $
Date of Payment
Receipt Number
ASBUILT *
I HEREBY CE.~HFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY,
Fox t[ill Subcl. ,~ot 4,]~1k. 3
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNE~ TO DETERMINE'THE EXISTENCE OF ANY
£ASEMENTS, COV£NANTS~ OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES $~OIJI.D
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINES~ OR FOR ESTABLISHING BOUND-
ARY LINES.
SEAWARD
1"=40'
5-19-91
GRID~
· 1~ 1458
20-64
DRAWN~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.munLorg/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
1. GENERAL INFORMATION
Complete legal description
Location (site address)
COSA#
Expiration Date:
Current Property owner(s)
Mailing address
Lending agency
I~"1 II
Day phone
Day phone
Mailing address
Real Estate Agent
Mailing Address
Unless otherwise requested, COSA w#l 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
TYPE OF WASTEWATER DISPOSAL:
Individual On-site [~
Individual Holding Tank []
Community On-site
[] Public Sewer []
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the Iransfer 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 peded of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B walls 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 show~ below, I vedfy that my Investigation,
based on procedures outlined in the Certificate of On-Sita 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 [-Jpe 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 cedes,
ordinances, and regulations in effect at the time of installation.
Eagle River Engineering Services
Name of Firm tn4:)1 VFW Rd.. Suite 201 Phone ~,o/~,.. ~ i<::J ~'
Address Eagle River, AK 99577
Engineer's Printed Name CJ.~is.-:~c,./-,,_..,-- ,'~. ,/~},9,or~ Date,~./2-//~
5. DSD SIGNATURE
I//' Approved for ~ . bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
By:.
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
. Other
Original Certificate Date: ~" ~" ~) ~
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water & Wastawatar Program
4700 Bragaw Street
P.O. Box 196650
Anchorage. AK 99519-6650
www.munLorg/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:
A. WELL DATA
We, type'P,-~V,~+'--
oae comple~
Total depth
Data of test
Static water level
Well production
FOX H/CL.. l...07' ¥
IfA, B, or C provide PWSID #
Sanitary seal (~1).~
Cased to ~'~O ft.
FROM WELL LOG
~? ft.'
gp.m.
Well Log(~/N) V~ S
Wires properly protected (~gl) ~
Casing height (above ground) ~ ~ in.
AT INSPECTION
roi '.:
P ~' g.p.m.
WATER SAMPLE RESULTS:
Coliform (~ colonies/100 mL
Arsenic: ~ mg/I
B. SEPTIC/HOLDING TANK DATA
Nitrate /. ·/ / mg/L
Data of sample: 7~o2/~ &
· ' - ~/o~Io ~
Other bacteria (~ colonies/100 mL
Collected by: ~{~d,~u'
Date installed '7 ] ,.o'~
Cleanouts (~)N)
High watar alarm
Length ~-~' ft. Width I.e' ft. ft.
Total depth 4,~J, ft, Eft. absorption area ~ Monitoring tube ~ Depression over field
Date of adequacy tast ~ Results J~Fail) ~ For ,~, bedrooms
Fluid depth in absorption field before test ~ in. Water added...~,~2 gal. New depth ..,~ in.
Elapsed Time: ~ min. Final fluid depth ~ in. Absorption rate >= ~'0 g.pld.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) r113,'~ /..-,,~ox.w If yes, give date ,-~
Gravel below pipe
Tank size J, ~ gal. Numar of Com~en~
Fou~n c~an~) (~ Depmss~n ~er tank
Date of pumpl~ ~ Pum.r
C. ~SOR~ION FIE~ DATA
Date ins~ll~ ~ [~4 ~il m~ng (g.p.d.~ o~
D. LIFT STATION ~
'~ level at in. High water alarm level at . in.
Cycles tested Meets alaml & circuit requirements?
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lit +' I C~ ~
Absorption field on lot 'f' I QC2 '
Public sewer main +'-~ '
Sewer/septic service line .r~-~ '
Animal containment areas +' I ~ '
On adjacent l/ts
On adjacent l/ts
Public sewer manhole/cleanout
Holding tank "f'
Manure/animal excrete storage areas
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 'f
Water main '/"-~ ,~ -f- IO
Wells on adjacent l/ts
Properly line .*~'
Water sewice line
Absorption field
Surface water
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line '1" lC>~
#
Water Service line -r I 0
Curtain drain + ~'O
Building foundation
Surface water -.t. I oO '
Wells on adjacent tits
Water main + I g~
Ddveway, parking/vehicle storage
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that I have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name d~P'/',5-/Lg¥~/'~f- ,~'.
Date
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waive~ Fee $
Date of Payment
Receipt Number
SG$ Ref.#
Client Name
Project Name/#
Client Sample ID
MaId~
1060581001
Eagle River Engineering
Fox Ilill Lot 4 Block 3
Fox Ilill Lol 4 Block 3
Drinking Water
All Dates~l'lmes are Alaska Standard Time
Pdnled Dare, Time 02/10/2006 I1:01
Collected Date/Time 02/0.2/200~ 15:50
Received Dare,Time 02/03/2006 17:00
Technlcal Director Stephen C. Ede
Sample Remmks:
Allowable Prep Analysis
Paramet~' Results PQL Units Method Container ID Limits Date Date Init
Nitrate-N 1.61 0.100 mg/L EPA 353.2 B {<-I0) 02/03/06 JC
A~enic
ND S.00 ug/L EP200.8 C 02/06/06 02/08/06 TK
SGS Ref3~
Client Name
ProJee( Name/#
Client Sample ID
&lalHx
PWSID 0
1060714001
£ngle Elver Engineering
Fox IIHI Lot 4
Fox Iltll Lot 4
Drinking Water
Sample Remarks:
All Dates/Times are Alaska Standard Time
Printed DateFfime 02/17/2006 11:26
Collected Date/Fime 02/09/2006 15:25
Received Dale/rime 02/10/2006 16:43
T~hnlcal Dlreetor Sfephen C. L'de
Results
PQL
Uniu Method
Allowable prep Analysis
Container ID Limits Date Date Init
N/cz'ob1 o1 oq~* I, abora t.o~ar
Total Colironn
COI/I OOmL SM20 9222B
A {<-II 02/10/06 TLF
82/86/2886 16:37
9073~4982!
J~TIC
ars l~mplag
PO Box 773415
Eagle River, AK 99577
(907) 694-6454,
K~m ~
EaSe R~v~, AK 9951/
(~e?) ~0~
P.O. Num~e~,
S~esJlp;
Mip BOOk:
22235 W;cd4:~ff Ceurt
(~oT) 688-39O6
Service Agreement
N umb~. 018315
8endceDale: Il-Oct-200§ 12;OOam
Tec~nk~nfl: Tony
Job Type New
Map O~d: 20
ICt~cked and pumped tank - nome dirt a~d reek in ~nk
~ ~ X ~ Men T~
S1~.~ ~ No S~.~
-
~ ~m: 3.8
01
Ne~Tmmble Total Tremble TMml
Eaflmaled Char~s: $130.00 $0.OO
Actual C~argM:
Cusip'nM IIQrll$ lO Ifl~ ~ ~ Ce(td4lk~qa O~ Ihll ~dce I~lemenL THIS iS A BINOIN6 AGREEMENT.
Tax TMa! Grand Total
~o. oo $130.00
~k~p~d by JRt Pum~ O~l~ AeM~ed
For your edde~ convenience we mcoe~ Amed~A F..~ee, Dicker, Vis~ aAd Master Card I~ymenb over Ihe phone.
A.q~r 30 Days ~coo~r~ will be lumed eyre'to collecfla~. $2500 Fro' NSF Chec',m Returned.
ASBUILT
I HEREBY CERTIFY THAT I HAVE SURVEYED THE
FOLLOWING DESCRIBED PROPERTY,
Fox Hill Subd.,Lot 4,Blk. 3
AND THAT NO ENCROACHMENTS EXIST EXCEPT AS
INDICATED. IT IS THE RESPONSIBILITY OF THE
OWNER TD DETERMINE'THE EXISTENCE OF ANY
EASEMENTS, COVENANTS, OR RESTRICTIONS
~HICH DO NOT APPEAR ON THE RECORDED ~JBDI-
VISION PLAT. UNDER NO CIRCUMSTANCES
ANY DATA HEREON BE USED FOR CONSTRUCTION
OF FENCE LINE~ OR FOR ESTAI~LISHING BOUND-
ARY LINES.
SEWARD
SCALE,
1"=40'
DATE,
5-19-91
GRID,
· t~W 1458
FB=
20-64
DRAWN, DMS
ASSOCIATES LAND 'SURVEYIN~ 688-4566
r75T."'
~'.. [S-6918 ...'~'~
Municipality o.f Anchorage
Development Services Department
Building Safety Division
On-Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www. muni.org/onsite
(907) 343-79O4
ON-SITE SEWEPJVVELL SUBMITTAL COMMENT SHEET
To: Chris Wood
Legal description: J=ox Hill Block 3 Lot 4
The attached paperwork has been reviewed and is being returned for the following reasons:
Original signature or stamp missing on
Calculation error in design.
Additional soils information needed.
Water monitoring results inadequate.
Discrepancy in information submitted. 3is there a hiC~lh wate~- olar~p on tank ?
Topographic information missing or inadequate.
Incomplete; missing
Incomplete; missing
Additional adequacy test information needed.
Water sample unacceptable.
Measured/proposed distances/dimensions missing.
Locations of all soils, percolation and water monitoring tests not shown.
Proposed system too deep for soils information submitted.
Well log required.
Omission in narrative.
Insufficient fill over tank or field.
[] Other, Need be'fret [readable] sur~ey with oil septic pipes shown,
Name of reviewer:. ,Teff
Date: 2-28-06
Please supply the necessary information and re-submit your request.
LEA VE THIS FORM ATTACHED TO THE PAPERWORK
MUNICIPALITY OF ANCHORAGE
Department of Health & Human Services
DIVISION OF ENVIRONMENTAL SERVICES
343-4744
Parcel I.D. #
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF
ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING
~_~\ ~ C"D'~ ~b- ~'~ NAA # ~--~c~(~,.~
1. GENERAL INFORMATION (Must be completed prior to submittal)
(a) Legal Description (include 10t, block, subdivision, section, township, range)
Lot 4; BlocE 3; Foz Hill Subdivision;
Location (address or.Cirections)
bu 6 ~ ~ c. Et-F? C/-~
22235 Wo4~liff Court
(b) Property owner State of Alaska Permanent F~.~tr~phone: (home)
Mailing Address "~,~O,"~c::¢ '¢~'-'"1~ ~.Or"J'~
,,
(c) Lending Institution Telephone
(d)
Business
Mailing Address
Real Estate Company and Agent ROSE PROPERTIES
Address 4175 .¢~rlr~ C~.¢,~ .gu.ZY-¢. //103
99508
Telephone 561-7550
ATTN: Te~'. or E.C.
Anchorage, Alaska
(e) Mail the HAA to the following address: (or check here [~.if hold for pick up.)
List contact person and day phone number below:
S & S ENGINEERING
17034 Eagle Ri,vet Loop Road No. 204
Ea~[Je River, Alaska 99577
TYPE OF RESIDENCE
Number of bedrooms __
Single-Family I~x
WATER SUPPLY
Individual Well E~X
Community [] Public []
Note: If community well system, must have written confirmation from the State Department of Environmental
Conservation attesting to th legality and status.
SEWAGE DISPOSAL
On-site ~X Public [] Community [] Holding Tank []
Note: If community well system, must have written confirmation from the State r)epartment of Environmental
Conservation attesting to the legality and status.
72-025 (Rev ;*/88) Page 1 of 2
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A. WELL DATA
~ MUNICIPALITY OF ANCHORAGE (MOA)
(~..~,) Health Authority Approval (HAA)
MUNI~,,.,,,,,,,,,,,,,,~F ANCHOR4;~iECKLIST- FEBRUARY 1984
ENVIRONM'k"~"T~L SERVICES DIVISION 343-4744
Well Classification
.J U L 1 8 ],990
RECEIVED
Legal Description: L-~:d"' ~' 'F'~b-4~''. '~ _
Well Log Present ¢¢2N) "/ Date Completed
Total Depth I~f'~-~ _Cased to ¢¥c;~Jr Depth of Grouting ---'-'
Static Water Level ~ ~ t Pump Set At ~ J/---- ,
Casing Height Above Ground i.~ tl..~ Sanitary Seal on Casing~'N)
Electrical Wiring in Conduit ~/N) '7/
SEPARATION DISTANCES FROM WELL:
I
To Septic/H'e44~ 'Tank on Lot ~ ~¢:~' ; On Adjoining Lots __
To Nearest Edge of Absorption Field_.0n/.Lot ' (~ ~----'~ ; On Adjoining Lots
To Nearest Public Sewer Line f'/"~ To Nearest Public Sewer Cleanout/Manhole
To Nearest Sewer Service Line on Lot '~
Water Sample Collected by ~-"~,¢~r ~;>
Water Sample Test Results ~/~"'~ ~'~
Comments
If A, B, C, D.E.C. Approved (Y/N)¢/'~'
Yield _ ~::). ~
Y
Depression Around Wellhead (Y~). f~
To Water-Supply Well
To Property Line
To Water Main/Service Line
B, SEPTIC/HOLDING TANK DATA
Date Installed ~//_~';~ Size ~ ~
Standpipesd,:.~N) k/ Air-tight Caps CF?N)
Depression over Tank (Y/,_I._I._I._I._I._~, f'~
Pumping/Maintenance Contact on File (Y/N) /
Holding Tank High-Water Alarm (Y/N) I'"/¢5'
SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK:
I
No, of Compartments
T Foundation Cleanout ~(5~N)
i%~ate Last Pumped; for ~ ~ [ ~:)~ ~'¢:::~
,/
Temporary Holding Tank Permit (Y/N)
Comments
To Building Foundation '~-~2r'1
I
To Disposal Field ~'
To Stream, Pond, Lake or Major Drainage Course
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
Depression over Field (Y/i~
Results of Last Adequacy Test
~//"//~ Type of System Design
Length of Field ~
Depth of Field '¢~'~ ~
Gravel Bed Thickness ,r-~.~::~
Statndpipes Present(~Ckl)
Date of Last Adequacy Test
SEPARATION DISTANCE FROM ABSORP~'ION FIELD:
To Water-Supply Well ["7 ~ To Property Line t c:~~ +-
To Building Foundati "'~"~ / To Existing or Abandoned System on
Lot ~/,~r- ; On Adjoining Lots '~;::~ / ~'
To Cutback (if present)
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
Date Installed
Size~_
"Pump On" Level at
High Water Alarm Level at
Tested for
Meets MOA Electrical Codes (Y/N)
Comments
Dimensions
Manhole/Access (Y/N)
"Pump Off" Level at
~'~'~V~n~uring Adequacy Test,
**Check Permitted Bedroom Rating Against HAA Request**
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect
inspection.
Signed S & S ENGINI~ER~NG
17034 giggle Ri','er Loop Roa~ No. 204
Company ..... ~: .....&l.s~a 99577
Date
MOA NO,
Receipt No.
Date of Payment
Amount: $
72-026 (Rev. 7/88) Back
Receipt No.
Waiver Fee: $
Date of Payment
Page 2 of 2
rate ~epo~t P~lated= JUL 18 90 I 08.'44
PRELIHINARY
Client Name
Client Acer
t,O.t NO~E
Req I
Se~ Repoztl to:
1)S & S ENGI~ERING
Sp.cial
~]~t :uct:
Chemlab Client Pera.r~etez
. Sample ! Sample DelC:lption Mat:ix To ~elt Method Ur~it~ Result
I 54 B$ FOX HIEL 1 80153-NIr~ATE-N EPA 353.2 .~'/l ~
MUNICIPAI. rf'Y OF ANCHORAGE
DEPARTIVlENT OF HEALTH AND ENVIRONMENTAL PRO'rECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTFIORI-FY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
GENERAL, INFORMATION
(a)
Application Date _~_~.-.~-" ~'~ ......
Legal Description (include lot, block, subdivision, section, township, range)
Location (address o~ directions)
(b) Applicant Name _;:~¢L4ac:L~_~_~-~,',*¢~_,'~,--~ Telephone: Home II~-~'~"~"-,~l',r~t-~_' Business
(c) Applicant is (check one): Lending Institution ~; Owner/builder'~ Buyer []; Other El (explain);
(d) Lending Institution ..... Z'V~.~._~_./'__~_~ .......
Address
.... Telephone
(e) Real Estate Company and Agent
Address
Telephone
to the fo,owir,. ddress:
TYPE OF RESIDENCE
Sin§le~Famil¥~r'?J Multi-Family [~1
Number of Bech'ooms ,';>
Other
WATER SUPPLY
Individual Well¢ Community Lq_ Public
Note: If community well system, must have written confirmation from the State Department of Environmental Conservation
attestin9 to the legality and status.
SEWAGE DISPOSAl.
Onsite¢.~.. Public E] Community E] Holding Tank []
Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation
attesting lo the legality and status.
Page 1 of 2 72-025 (11/84)
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 th~s Hea:'.n
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 informabon obtained
from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supph/ and or
wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on
tbe date of this inspection.
Name of Firm _ ,~,~:,~:~m~:~ Telephone
Date . 1, ...... :--' ~V ¢_S
DNEP APPROVAL
Approved for (":/_ bedrooms by
Approved ~" Disapproved
Terms of Conditional Approval
Date
Conditional ~
CAUTION
The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health
Approval certificates based solely upon the representati.ons given in paragraph 5 above by an independent
engineer registered in the State of Alaska. ']'he DHEP does this as a cou~lesy to purchasers of homes and their [e~diug
institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections
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 (MOA)
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST - FEBRUARY 1984
264-4720
WELL DATA
Well Classification ~2._~,'~, If A, B, C, DiE.C. Approved (Y/N)
Well Log Present) Date Completed _ '¢~/~'~-~' Yield
Total Depth i,~d~. I _ Cased to "¢fDr"~- ~ Depth of Grouting '-"-'"'-
Static Water Level ¢']"'/ ¢ Pump Set At k..)
Casing Height Above Ground '"-~°~'* Sanitary Seal on Casing~N)
Electrical Wiring in Conduit ~N) '* Depression Around Wellhead (Y~'~
Separation Distances from Well:
To Septic/~o!,Jh~fl-Tank on Lot \ (~¢ ~ ~ +1: ; On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ~¢'7 ~
; On Adjoining Lots
To Nearest Public Sewer Line ~.b/~ To Nearest Public Sewer
Cleanout/Manhole ¢_b JA To Nearest Sewer Service Line on Lot
Water Sample Collected by ~ ~,,~_~t~Z~'z-(.~c'~ ; Date __ ~-'~-?.~'
Water Sample Test Results -
Comments
B. SEPTIC/I'-I~ERi~:-TANK DATA
Date Installed
Standpipesl~N)-'
Depression over Tank (Y~
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) tO/,,.,.,.~
Separation Distances from SepticS=le~tk~-Tank:
To Water-Supply Well
To Property Line ____~ ~-~ \
To Water Main/Service Line \ ~ ~'~'
Course
Size ~_~z~r--) No. of Compartments '~-'
Air-tight Caps~N) '* Foundation Cleanout(C~N)",,
Date Last Pumped
/
/~G. ; for
Temporary Holding Tank Permit (Y/N)
To Building Foundation
To Disposal Field
To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata '~-~ ~ /I;~¢t-''''/ Type of System Design
Date Installed r7-- ~'~ ~ Length of Field ~---~ '
Width of Field , ~ /~ / ~'~" Depth of Field ~
¢C~S_ ~'%"~A ~ Gravel Bed Thickness
Square Feet of Absorption Area ~ ~
Standpipes Present(~N) ~
Depression over Field ('~j)-'
Results of Last Adequacy Test
Separation Distance from Absorption Fie~d:
To Water-Supply Well ~t e~ ~ 42:
To Building Foundation .~..~r~ I
Lot ~.5 )IA
To Water Main/Service Line
To Stream/Pond/Lake/or Major Drainage Course
Date of Last Adequacy Test ~'~-----~
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots
To Cutbank (if present)
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
Electrical Codes (Y/N)
Dimensions
Manhole/Access (Y/N)
~_~ "Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to~//all MOA and HAA~?uidelines in effect on the date of this inspection.
Signed ~,~ ..............
Compa~,y ',,, ,., ~.,,,.;.R..B
Receipt No. · ........
Date of Payment
Page 2 of 2
72-026 (11;84)