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HomeMy WebLinkAboutATELIER BLK 1 LT 3Aan ier f� #041 -osi -n municipality of Anchorage Development Services Department Building Safety Division Onsite Water & Wastewater Program, 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SWUA40373 041-031-77 - PID Number. Name: MONTE KIRSCH CAMPBLE AIRSTRIP ROAn a Afdf WnwACr AV nrt.r,1 o� A, a., aw ♦ir Page 1 of 3 Wastewater System: ❑ New ■ Upgrade A C1�Ar\AT1A� -- Phone: —,w%jwnr l Kim r'ICLU No. of Bedrooms: (907) 338-3833 4 ■Deep Trench OShollow Trench 118ed OMound ❑Other LEGAL DESCRIPTION �""° T°°al tech f^m -V-1 "r Block: Lot: Subdlviston: 1 .2 FL - 10 MAX. n. . 1 3A ATELIER Depth ro aa.,_j W. gbrol q ae,: Drax fig, �th pip.: Towns Range: — Section. — .98 MAX.or 3.98 MAn, iM aee.e abaw atginW yrotl,: 6.02 R fAawl l,ngih: SEE DWG. FL 45 WELL: ❑ New ❑ Upgrade crow width` 2.5 R Numb« w u - D, anw wlw«n Cbwneatbn priwb, A,B,C): Total G Crowd To: (ipeoall Ft. Ulol abmn tion awe: 1 _ R Ph, mato : Drill„: R R Date p'IIMd: static wobr lev,l: 540+ m. FL batalMr: D 3034/ F-810 Y41tl: R GEG, Ltd. Odtw In,t,II,E: 10/12/2004 Pump Set At Caring NNgln Ab,w Ground: GPM rL TANK SEPARATION DISTANCES ■Septic Cl Holding OS.T.E.P. Cl Other To Septic Absorption flit Holding ublk/Prhnt. From Tank Fleur station Tank S,wer u „ MonWaoq,ror; Capxib In eauanr. ANCHORAGE TANK 1250 Well 100'+ 100'+ — — 5'+ 25'+ Mate STEEL or oampanmmb: 2 Surface water ,ao'+ 100'+ — — — LIFT STATION Lot Line - 5'+ 10'+ — _ _ St. in 9011... Monufoptura: Foundation 5'+ 10'+ — _ _ p on 1 w 0c rnp Aro at: High w , ebrm at: Curtain Drain NO KNOWN Pump Mels tb ModN: 17x1"0°1 n p.,H n p,rrorrrwd by: Remarks: BENCH MARK THE OLD SEPTIC TANK WAS COMPLETELY tax PATIO DOOR THRESHOLED ABANDONED PER UPC. A,wr,w0 l7,xtbm. 100.00 it ENGINEER'88 0 4 �S�O Inspections performed by: GEG, Ltd. T -7 0, Dates: 1st 10/12/2004 *;, , 2nd — 3rd — Gar ess: Development Serv'c s Departm nt proval �4 c ` w� O�D�Dea /79 Reviewed and approved by: Date: I—/O-D It'lr��°�°�'�� (iM1r. t�Dt) Profession 00 ��0040p00 PERMIT NUMBER; AS BUILT DRAWING PARCEL ID SW040373 — 04T-0311 — NEW DRNNFlELD �. ALTERNATE SITE ,n C NEW 1250 / GALLON / SEPTIC TANK A A FCO' 40.51 26.36 ic7rEXISTING ,.. , ST1 43.67 37.16 ExlsnNc weLL ST2 49.43 41.52 (BV)ALTERNAT vavE DBL1 51.02 43.23 DBL2 51.93 43.92 1 BV5STING TRENCH 4.40 45.99 TO BE USED AS C01 77.69 73.02 A RESERVED srrE MT1 77.74 72.24 CO2 104.95 65.30 MT2 105.54 66.51 DATE: 10/15/2004 DRAWN BY: 0,C� .. . .. R.A.L. \•'' GARNESS ENGINEERING GROUP, Ltd. �r p CONSULTANTS: GENERAL CONTRACTORS SCALE: `�: 4'•y 00 3]01 E. TVDOR ROAD, SUITE 101 • ANCHORAGE, Al 99507 • PNONE (90]U3]- 61]9 • FAX (907)338-3246 1 ~ 40• • • • • ........ n °REPARED FOR: PHONE NUMBER; PAGE NUMBER: Ty�� MONTE KIRSCH (907) 338-3833 2 OF 3...... •••••• EGAL DESCRIPTION: OOP .f y amess.. ATELIER SUBDIVISION; LOT 3A, BLOCK 1, �� CE— 95 .�� YPE OF WORK: O se. ''IQ�.��f AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE ��P�ofesslo^o�c ���4000�00 PERMITNUMBER: AS -BUILT DRAWING PARCEL ID NUMBER: SW0 SW040373 041-031-77 FINAL GRADE 97.94-98.38 ST7 F4 INSULATION . ST2 TOP OF TANK AT INLET - 94.96 - INVERT OF BUNG AT INLET s 94.39 n L4 NEW 1250 GALLON SEPTIC TANK ORIGINAL GRADE / ' INSU5.58 LATION 95.27 1 2' INSULATION i -FILTER FABRIC PIPE BOTTOM OF TRENCH 85.27 RELATIVE ELEVATION OF -A.11 GROUNDWATER IN TEST HOLE O 74,73 RELATIVE ELEVATION OF BOTTOM OF TEST HOLE O 78.77 10/15/20 DRAWN 8Y: GARNESS ENGINEERING GROUP, Ltd. R.A.L. CONSULTANTS S GENERAL CONTRACTORS SCALE: 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AN 99507 • PHONE (90])33]-0179 •FAX (907)338-3246 1"=40' PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MONTE KIRSCH (907) 338-3833 2 OF 3 LEGAL DESCRIPTION: ATELIER SUBDIVISION; LOT 3A, BLOCK 1, TYPE OF WORK: AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE TOP OF TANK AT OUTLET - 94.93 OF BUNG AT - 94.13 . .... ....... :.*..� 0 f e �Qn . - Ga Hess.: X : OG MUNICIPALITY OF ANCHORAGE Development Services Department Onsite Water 6 Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Initial Permit Number: SW040373 Legal Description: ATELIER BLK 1 LT 3A Design Engineer: 0855 Gamess Engineering Group, LTD Owner Name: MONTE KIRSCH Owner Address: 9321 ATELIER DRIVE ANCHORAGE, AK 99507-1201 Date Issued: Sep 02, 2004 Expiration Date: Sep 02, 2005 Parcel ID: 041-031-77 Site Address: Lot Size: 106212 SQ. FT. Total Bedrooms: 4 Permit Bedrooms: 4 This permit is for the construction of: F✓ Disposal Field Z✓ Septic Tank Holding Tank 0 Privy Private Well ❑ Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specked in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 I. 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and dosed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: 9 Date: o Municipality of Anchorage Development Services Department Building Safety Division < On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.cl.anchorage.ak.us (907)343-7904 ON-SITESEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. _ t4l-,M' � ;[ Permit Number Property owner(s) MONTE KIRSCH Day phone 240-8430 Mailing address (1) _9321 ATELIER ROAD + ANCHO me eu Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd.) LOT 3A. BLOCK 1 • ATELIFR SUBDrVISION Legal description (Section, Township & Range) N/A Lot Size 1060 WAcres/Sq.Ft. Number of Bedrooms a THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi ❑ Swimming Pool ❑ Water Softening Unit ❑ Therapy Pool ❑ I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal codes. GARNESS ENGINEERING GROUP Ltd. Permit Fees: `700'6D Waiver Fees - Date of Payment: _$` 0 (Aa' f7 Date of Payment: Receipt Number. --& '1 Q5_L1' �_ Receipt Number: GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS August 25, 2004 Municipality of Anchorage Development Service Department Building Safety Division On -Site Water & Wastewater Program P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Proposed Septic System for Atelier Subdivision, Lot 3A, Block 1. To whom it may concern: The existing 4 bedroom house is served by a private well and septic system. The septic system is currently in a state of failure and must be upgraded. A test hole was dug on the property. The drainfield will be designed around the 35 foot radius of this test hole. We are proposing that a new 1250 gallon septic tank and also a deep trench type drainfield be 'installed. Comments regarding the design are summarized as follows: 1. SOILS: See the attached jog which shows the soil classifications, groundwater monitoring, and the percolation test results. It is our opinion that due to the overall appearance of the soils, an application rate of 1.2 gallons/day/R2 should be used. 2. TRENCH DESIGN: a. Percolation Rate: <1 minutes/inch b. Proposed Application Rate: 1.2 gallons/day/ft c. Number of Bedrooms: 4 d. Design Flow: 600 gallons per day e. Minimum Absorption Area: 500 ftZ f. Total Depth: 10 feet (max.) g. Effective Depth: 6 feet h. Width: 2.5 feet i. Reduction Factor: N/A j. Minimum Length: 45 feet long total k. Effective absorption area = 540 ft 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed septic system. 3701 E. Tudor Road, Suite 101 • Anchorage, AK 99507 Ph: (907) 337-6179' Fax: (907) 338-3246' Website: gamessengineering.com 4. TOPOGRAPHY: As can be seen on the attached topography site plan, the average topography in the area of the proposed drainfield is approximately 10-20% running southeast to northwest. In short, there are no slope concerns. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have any questions, please contact us at 337-6179. Thank you for your assistance. M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineering.com ATEUER S/D; LOT 1. BLOCK 1. ATEUER S/D; TRACT 0-34 ATEUER S/D; LOT 2. BLOCK 1. PROPOSED SEPTIC UPGRADE (SEE PAGE 2 OF 2) I I II II ' � I t1/ in I I% I � FIELD VERIFY QQ� ) p, ATELIER S/D; LOT 4. BLOCK 1. ATELIER S LOT 5. DATE: 8/25/2004 OF h DRAWN BY: a A.J.G. GARNESS ENGINEERING GROUP, Ltd. �d� CONSULTANTS O GENERAL CONTRACTORSSCALE' 5701 E. TUDOR R04D, SUITE 101 • ANLHOR4GE. AK 9950] •PHONE (907)357-6179 • FAX 90])338-3246 1" — 100. PREPARED FOR PHONE NUMBER: PACE NUMBER: - MONTE KIRSCH 338-3833 1 OF 2 LEGAL DESCRIPTION: (� . ATEUER SUBDIVISION; LOT 3A, BLOCK 1, pp°s, 7953 TYPE OF WORK: Y� rs sc-6' SITE PLAN OF PROPOSED SEPTIC SYSTEM UPGRADE �d0 "Of°8810 0\ 10t1`a`'+�� 43I3o 0 C� NT PROPOSED DRAINFIELD: INSTALL A TRENCH 45 FEET LONG BY 10 FEET DEEP BY 2.5 FEET WIDE ADD 5 FEET OF CLEAN WASHED SEWER/1 •f DRAINROCK. INSTALL TRENCH wr A / ' PARALLEL TO SLOPE CONTOURS. CO INSTALL FLOW DIVERTER . •• NEW 1250 GALLON EXISTING 4•~�•` •.r'�': .SEPTIC TANK BEDROOM ;•': y HOUSE EXISTING WELL • OLD DRANFIELD TO BE :• USED AS ALTERNATE SITE L • . , ' _• .:: OLD SEPTIC TANK TO BE: .' �:, �• -' ABANDONED PER UPC :.••. EXISTING FOUNDATION CLEANOUT SATTEUIE DISH 0 NOTE THE CONTRACTOR SHALL \ HAVE THE NORTH LOT LINE `�• AND THE 100' WELL RADIUS FLAGGED BY A REGISTERED LAND SURVEYOR PRIOR TO CONSTRUCTION. vni c: 8/25/200 ,. DRAWN BY' GARNESS ENGINEERING GROUP, Ltd. SCAE.'a.I.c. CONSULTANTS& GENERAL CONTRACTORS i� = 4O' 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 • PHONE (9077337-6179 • FAX (907)338-3246 PREPARED FOR: PHONE NUMBER: PAGE NUMBER: MONTE KIRSCH (907) 338-3833 2 OF 2 LEGAL DESCRIPTION: ATELIER SUBDIVISION; LOT 3A, BLOCK 1 TAPE OF WORK: DESIGN DRAWING OF SEPTIC SYSTEM UPGRADE I TIA r GGrness:' D OQQ� CE -7953 ,•'`Fe�j7 �.e ,ao GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS i GENERAL CONTRACTORS 3701 L I%VM WA NIXIE tot -- NICIIORIo& A 00307 • RME 00 -0170 • 7N0 k • NEMM- •nnwrigk--kq. ISOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: ATELIER SUBDIVISION; LOT 3A, BLOCK 1 PERFORMED FOR: MONTE KIRSCH DATE: 8/13/2004 DEPTH ((feet j 1 5 6 7 8 i .�;i ORGANICS SOIL QLASSIFICKTIONS 8/13/290 15.5 •' 11111111 ML 11.111!11 CL INNII • swMH II1111111 N SP//%CH �'.4.d. • �4.`.4,�.., Vi��a.4ii!sc 10 .�;i SP 8/13/290 15.5 8/24/2004 11 12 13 14 ��•1 N 15 •�i�y� 16 V 19 DEPTH TO GROUNDWATER DATE DRY 8/13/290 15.5 8/24/2004 :ACMTD PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 4.0 FT. AND 4.5 FT. 20 A FOUR HOUR PRESOAK WAS PERFORMED: ® YES ❑ NO SOILS LOGGED BY: JENS JENSEN PERCOLATION TEST PERFORMED BY: ROB CAMPBELL COMMENTS: PERFORMED BY GEG, Ltd. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS ERF R ED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE: V ojg MUNICIPALITY OF ANCHORAGE 0 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 FSM.[1Y` PHONE �q 3�3't'OCJ r NEW ❑UPGRADE MAILING ADDRESS ["A-( T i �Z - LEGAL DESCRIPTION 10 L3 6 c T -i-,L- LOCATION NO. OF BEDROOMS UY DISTANCE TO: Well i .+ (an Absorption area w(,T Dwelling v2 �/ PERMIT NO. SZ(��7�� H z W Fa Manufacturer Q zs Material L No. of compartments �- w Liq. rapacity in gallons -Z5_0 IF HOMEMADE: Inside length Width �- Liquid depth Y J a z DISTANCE TO: Well Dwelling PERMIT NO. OZ< Manufacturer Material Liquid capacity in gallons w= DISTANCE TO: Well Foundation Nearest lot line f PERMIT NO. J u. Z H Z ul No. of lines % Length of each line Total length of lines Z Trench width ^- (, inches Distance between lines r p Top of tile to finish grad — il Material beneath t / S inches Total effective absorption area w Length Width Depth PERMIT NO. QI- as W Type of crib Crib diameter Crib depth Total effective absorption area W DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. 20U i LU DISTANCE TO: Building foundation Sewer lines / �✓ Septic tank/ Absorption area(s) OTHER N UAA11 PIPE MATERIALS 3� SOIL TEST RATING INSTALLER c r REMAR S yW'+4-2 P APPROVEDDATE LEGAL 72-013 (Rev. 3178) 6-11 U, tol K_j 01 1 10 1: Fit 1.. :1 0- FA C! bi �j F1 fl:'it�����- . ' DEPARTMENT OF HEALTH HND ENVIRONMENTAL PROTECTION 825 'L' STREET, HNCHORHGE, HK. 9950 264-4720 � ����_ ����� ����� _��� ������ ��PERMIT NO, ( 820041 APPLICANT DEXTER F. SMITH 8241 MAJESTIC DR [�~~\� c}/\d)oa LOCATION ATELIER DR LEGAL L381 ATELIER LOT SIZE 741]] SQUARE FEE � TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH -'�f - s 10 ` ^~ MAXIMUM NUMBER OF BEDROOMS = ] SOIL RATING (SQ FT/BR)= 125 ------ THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: X « �EE Fin w wi= �1_ L_ FE 21 W C3 FT Fil 4A FIRE 1L. �����us THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIE THE DEPTH OF H 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). KFEECTIR.J I KEEE> n5lisil"K :1 0 -T-FAP4K I.E:EE= PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE MUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ___ "7- 01 r,.*o ���> ���Fn EE C.':: "T :1 rA no FA FIT EE K E" Ca LJ :E F1 EE E> BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN H WELL HND HNY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING UP[N THE TYPE OF PUBLIC WELL MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS OF THE WELL COMPLETION. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. 1"AFEEKV1 1 7' F ��*ET to." I CERTIFY THH7 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SE FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN ] BEDROOM SIGNED: ............................................ APPLICANT DEXTER F. SMITH ISSUED BY—1 ..... '__.... .... ..... .... .... ..... .... '_ / ..... DHTE_____. / ..... .... ..... / '_z�� Y4. 0 R = k a f"'{�■■;'t�.f4�t���.f-!t i'�. � :^t{?.. �'J•.d�:�i. fa�''41Z f'izi;>'; Ci°3#.#{'# ,l-Rjt-JPROM z';! f I!, hrt l [ t lt3 �'yt�t � i .''fir' `= .•� _ #,.:Zee ?'}.t- t't#}zl'f t*.t>^#s =fsz'k €'�'� r_ I�}:t€� ' Its }_j{a #:i �#i#.#t'io nric, nli: '-:,,o rum cv TH., i'r #' rasa;1`,� 1� i r• i bi Va Yui:= MINIMUM OEP r; # CIF f -O #_ ' tr-tL ;Jjfff)M tom= D- _ f : S-=,. sC>_ < x t I f;l &r -t _ I.-.. 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' +1,i� j' rt �. �{ 4 .�, r z.�7r ,a #ltrci t_.t�+ �� i i. �° .-,,1#� cf ,�.� rty, it.?'�;+.#; � ; ,}^,•t_1�-��� f.l�`� fi�l#_i._€`iT Ir�l�. s t ti 1 T+ � . . r{ : t r'� i t-� .'.r.`.;.. l L i ' ` �'H:: �� +� '.9. a" J .#�'t } }i �' `'.� Z � : ' �.i :. #'•'•.�''•'•'' i'���� . � } � `�• � �' �'�"a. f i.<.}}'.'. �•i`: =+a#` � r,. �'���#i # { t<' �t-'#^5�.� � �'1� f-�e - i��'�7,�s�f��i':'t'�'. i W;4_3 :;�.s# :.i .1q, -K vr' _• �'3 ?` :: `� # i=7 i}.1 (i': '� { ' s t �t i' ' 34I It' -- i #t V4, r An • 0 3 :WI -0 " c a r Tom Tl Y r 1 n c 1 1 J vis r, ;1,.' n n ' r.na1-scrintic,n: at 3__E' e r cc1rtion l - 7hiS =orm Nnar'ts Sails Lon Y.'- _ rer th Soil char ctef"istics Tret rn R�,ci%ii- h Stlt _ _ _ z- f X11 I ► ► - SI ght;l_y silty Sana rr,�velly Sana l �., r.lk P ' f 1 ilii _ I t t'�a ter Bottom of test We ! Rep J'�Mock I I I t 1JO c.'cl C OC-}: �'!�ll!..I f: C' L r'd I I j i �,zs rnt;ni ter Encountered? At what Genth? .......... ...._ I r. -,r, i roc 1 f`��,te Grnss Time , I a Perco at inn Fit ,,rain Field „ t Sf ndc� _ r;�_f) I nt rased Invtal latlon' Penth To o�?-,In 0 F t Cr i r f -,th of In1et„ (_O 5.. �J„f.. .F f� I 1.50 ;(1L137 fOOt l ('r-lll]_i(.(� }> r }.Ir -C1 i."rrC!n fl"( In (1 .illllS 6 1.25 squire Foot_ required per bedroom rrom minus 5' c.o 15' . 2204 Cleveland hnchoraye, ?'.'-._sha ?9503 Performed For yTom Taylor -_-__- ------ ----------.-----__-Da e Performed 7-30-77__._._-- enal r,escrirtion: Lot—B1ocivision This Porm Renorts Soils Lon Yes -- — --Percolation enth t FeSoil Characteristics _ I"_ �eac�isri" BIS - 4.___ Slightly Silty Sand - Gravelly Sand - - - -� i Water 1 ' 16 + i. Bottom of test hole I j 18 No bedrock encountered ( ' 1`E 20_._ ---------------- ._1- I-'-1_.� Vas ;=round Water Encountered? - Yes -i _TPI - 0 1- 66 if `'es, At What Depth? 14 5' 1 Ffiacirc Date Gross Time Not Time Depth to H2O Net - --- - - - - - - - reraolati-An Pa¢e minute Proposed InSA latSn. St .race Pita �� r in Field _ Roth of Inlet _-nth io SAW 0` Pit Or f ! NEN I S" .1.50 qure foot requi,ed per bedrogin from Tft.l-nus 6'+_- o 5"...__ _ 125 square _foot required per bedroom from minus 5' to 15' . i ` 11 J1 Vas ;=round Water Encountered? - Yes -i _TPI - 0 1- 66 if `'es, At What Depth? 14 5' 1 Ffiacirc Date Gross Time Not Time Depth to H2O Net - --- - - - - - - - reraolati-An Pa¢e minute Proposed InSA latSn. St .race Pita �� r in Field _ Roth of Inlet _-nth io SAW 0` Pit Or f ! NEN I S" .1.50 qure foot requi,ed per bedrogin from Tft.l-nus 6'+_- o 5"...__ _ 125 square _foot required per bedroom from minus 5' to 15' . i ` Date CASING LOG' I Time Depth Materials and Remarks Length LengtTotal h 0 /115 Depth -Begin Shift Depth -End Shift Depth Drilled TIME DISTRIBUTION HOURS Drilling Pull Casing Pumping Standby Surging LABOR EQUIPMENT Name Hours Item Size Hours Crane Drill -Rig i r4, 41/1' Flatbed Pickup Boom Truck Welder Compressor Generator P Not PLf)nlAq 4 2) 610y-fi (lop �ko, P", MUNICIPALITY OF ANCHORAGE PrPT Or !!. ENVIK j It,` J i, A.. 1 :0 E. "I �4 0 KLU I _V LL) No. Depth Sample Description DRILLER INSPECTOR w IE ES A C STATE SS 0 RN INC.A/ T19 C 633 EAST 81ST AVENUE ANCHORAGE, ALASKA 99502 SUBSURFACE EXPLORATION Shift Report of Operations Name Address City,!" X, Project to Static LevelSize �--'GPM-YIELD Depth -Begin Shift Depth -End Shift Depth Drilled TIME DISTRIBUTION HOURS Drilling Pull Casing Pumping Standby Surging LABOR EQUIPMENT Name Hours Item Size Hours Crane Drill -Rig i r4, Flatbed Pickup Boom Truck Welder Compressor Generator Pump Not PLf)nlAq 4 2) 610y-fi (lop �ko, ALASKA ENVIRONMENTAL CONTROL SERVIC , INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561-5040 JOB Lo7" 3 344ew, l ^641 /r,e s�b SHEET NO. OF CALCULATED BY �' Hurd DATE' CHECKED BY SCALE / 30 DATE Municipality of Anchorage Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.d.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcell.D. 041-031-77 HAA# (A U51I 1. GENERAL INFORMATION Expiration Date: -tea — / (0 — d -� Complete legal description Location (site address or direct) Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address MONTE KIRSCH Day phone 338-3833 CAMPBELL AIRSTRIP ROAD • ANCHORAGE. AK. 99507 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 4 3. TYPE OF WATER SUPPLY: Day phone Day phone TYPE OF WASTEWATER DISPOSAL: Individual Well 10 Individual On-site Individual Water Storage ❑ Individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ❑ Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) Issues Certificates of Health Authority Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 samples. (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 this application, investigation, based on procedures outlined in the Health Authority Approval Guidelines forshows that the onsite water supply and/or wastewater disposal system is(sre) 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 onsite water supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 • ANCHORAGE, AK 99507 Engineer's Printed Name JEFEREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines 6 Regulations. The reported results described the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily Identifiable features. he operational ratin l I s tOf hat all mwells and may systems depend on the local soils condition, groundwater fluctuate during the year, and the water usage of the family being served by the system. These conditions are outside the control of the evaluator of the system. Satisfactory test results do not guarantee future performance of the system, or do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or MOA DSD. The content of this report is for the sole person benefit of party owner Is of aiisted above. Any uthorized, nor will it confer anance y legal Trigor use ht this whi ereport oever. any ..other person or party 5. DSD SIGNATURE ✓ Approved for 4 bedrooms. Disapproved. Conditional approval for Attachments: v HAA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date o L bedrooms, with the filowing stipulations: Manitenanoe Agreements Supplemental Engineer's Reort Other vr-.• -.•� 0 �� , r R AND t �p 3nGRAM • 01 By:(/ el— /(/ %� Original Certificate Date: O (Rev. 7201) Municipality of Anchorage } ' Development Services Department`= Building Safety Division G On-Site Water & Wastewater Program ' 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 f www.ci.anchorage.ak.us `(907)343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: ALTIER SUBDMSIONo LOT 3A. BLOCK 1. Parcel ID: 041-031-77 J A. WELL DATA Well type PRIVATE If A, B or C provide PWSID# N/A Well Log (Y/N) YES Date completed 4/21/1982 Sanitary seal (YM) YES Wires properly protected (Y/N) YES Total depth 80 ft. Cased to 80 ft. Casing height (above ground) 12+ in. FROM WELL LOG AT INSPECTION Date of test 4/21/1982 8/10/2004 Static water level 48 $, 50 ft. Well production 50 ®.p.m. 4.8 g.p.m. k WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Nitrate 0.10 mg./L. Other bacteria 0 colonies/100 mi. Arsenic: N/A mgJL. Date of sample: 8/10/2004 Collected by: GEG. LtD. B. SEPTIC/HOLDING TANK DATA Tank Type/Material STEEL Date installed 10/12/2004 Tank size 1250 gal. Number of Compartments 2 Cleanouts (Y/N) YES ° Foundation cleanout (Y/N) YESDepression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping NEW Pumper ' C. ABSORPTION FIELD DATA Date installed 10/12/2004 Soil rating .p.d. r ft%bdrm)1_2 System type DEEP TRENCH Length 45 ft. - Width - 2.5 ft. Gravel below pipe 6.02 ft. ` Total depth •to ft. Eff. absorption area 540+ ft' Monitoring tube YES Depression over field NO Date of adequacy test NEW Results (Pass/Fall) PASS For 4 bedreoms� Fluid depth in absorption field before test _ in. Water ad New depth _in. Elapsed Time: — min. f p in. Absorption rate >_ g.p.d. A ion treatment (past 12 mo.) (Y/N &type) NONE KNOWN If yes, give date i i; i Date installed "Pump on" level at _in. E. SEPARATION DISTANCES Size in gallons High water alar level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 100'+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 1001+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A , Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 5 + Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printec/� Na/me JEFFREY A. GARNESS Date to /Zz(oOf M HAA Fee $ —1 �1- ) Date of Payment Receipt Number y (Rev. 12101) Waiver Fee $ ffiffiffflow Date of Payment Receipt Number df \ 'fit add �3 08-18-04 08:05AM FROM-CUE ESI, SGS ENV SERVICES —sf3$— SGS Pau 1044906001 Client Name Games Engineering Group, Ltd. Project Name/# Atelier Fill, UA Client Sample ID Atelier 81, UA Matrix Drinking Water 9075615301 T-651 P.02/03 F-063 All Dates/Tlmes are Alaska Standard Time Printed Date/Time 08/17/2004 11:41 Collected Date/Time 08/09/2004 11:24 Received Date/Time 08/102004 16:55 Technical Director Steahen 11. Ede Sample Remarks: Allowable Parameter Results PQL Units Method Container ID L "s D eat =ls Tait Water® Department Nitrate -N 1.77 0.100 mg/L BPA 300.0 B ("10) 08/10/04 JIM Microbiology Laboratory Total Coliform 0 col/100mL SM20 9222B A (<-1) 08/10/04 DKC 08-18-04 08:05AM FROM-CT&E ESI, SGS ENV SERVICES 9075615301 SGS/CT&E ENVIRONMENTAL SERVICES Drinking Water Analysis Report for Total Coliform Bacteria READ INSTRUCTIONS ON REVERSE SIPE BEFORE COLLECTING SAMPLE MUST BE COMPLETED BY WATER SUPPLIER PUBLIC WATER SYSTEM IPI ClIP'NIVATE 19M SYSTEM Iff sand ResultsSara Arvoica ❑ Sand Results rsr.amCelowo Nes. Rmm N~ Fu NrNo.r meene rq sNn. Ly c.a. SAMPLE COLLECTION: Pet&: Tim.: 1 Location: i Collector [ T-651 P.03/03 F-063 200 W. POTTER DRIVE ANCHORAGE, ALASKA 99518 Tel: 907-682.2343 Fax: 907-581-5301 1 Lab Rer No. 104490 I�Illlm Q sand invaim ar.im,IMnna:olm.gNa,a Gr.r Nwn. 1 Pear"wow I a."MOM Marty Ad*. Ow y 00. SAMPLE TYPE: IJ Routine ❑Treated Water ❑ Repeat Sample `' Untreated Water (refer to lap no. 1 ❑ Special Purpose Transported to Lab By: rk6ame as collector Other mw sme sur. TO BE COMPLETED BY LABORATORY Sample Recelvina: Date: `�� ❑samplemer30hoursad; ❑ RUSH SAMPLE Time: Results may he umeliabk Tem " ❑ 4 Hour Phone f: Delivery Method: Received By: f ��— __ o....n u.... _mid ._ comments: Fax it. ..................................................n.......................................................................................... Bacterioloarcal Water Analysis Record: SBrd to ADEC: MMO-NUG (PIA) RESULTS: - ANC FBK JUN Analysis Beam: $ IID I LI f -1 I S Total CaMorm: IDstrAline: Analyst: E. Colt Analytical Method: ® MemOrane Filter ❑ MMO-MUG (PIA) MEMBRANE FILTER RESULTS: Direct Count _1, Colonies1100ml. Verillca0on: Ta.laalaaLTH: BGE• r..rC. { EC: sent to Olen Phoned Foxed C] OawTane: 9 to vAft ® Satisfactory ❑ Unsatisfactory 7Nre-T.. Nee lMC.eM Reported By: --t7. Io -e'! DateMms: _.t;Irg )2--mp as •oewa•me. Simrwn Form k FW" 0053 12117/03 MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parce1..I.D. # HAA # O 3-d 1. GENERAL INFORMATION Complete legal description T 3Ar BwexI. /)'7"cLjt- SCIS Location (site addressor directions) Property owner Dexr'ce F SmiT-w Day phone Mailing address Lending agency Mailing address Agent _ Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water Day phone Day phone 3L/y- 46'T1 NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025(Rev.1/91) Front MOAR21 LZk Vow MOOS (16A •Aei!) GMZL -i jom sdeauibuo psuoissajoid eqj ui suoissiwo ao saoaae aol 9psuodsai IOU si 96saoyouy }o Ajipdioiunw eq l -penssi si opoilpeo s aaolaq sIsp Wine ao suoitoedsui jonpuoo IOU op SHHo jo s9eAojdi.u3 -s;uawaiinbei elels pus paapa} uisjeoA4sijss ojaapao ui suoi}nlilsui Buipuel aiegl pus sawoy }o siessgoand o} Ase:pnoo s se sigj scop SHHo ayl -e�ssjV jo eje4S ayj ui paaaIsiBei aaeuiBue puoissepid luepuadepui we Aq anogs 9 gdsaBsasd ui UOA16 suoijejuasaidaa aql uodn Aluo peseq s91e0111IJ90 Isno.iddy A}iaoy;ny 41189H sanssi (SH H(l) seouuaS uswnH pue gIIsaH jo ;uawpsdea 96saogouV jo Aj!pdioiunw eql I NUIIIIGJ . alu( :Aq sluawwo0 leuoilippy :suoijuindils buimollol eqj qj!m `swooapaq se 4 -. ? A! JOI Ienoidde 1eu0111pu00 •panoJddesia -swooapaq G JOI panoaddy 3df11HNJIS SHHo '9 einjeubis s,a99ul6u3 S6 7 -179 oto LLo) 2 I/Og •p, sseippy p 1 b -. g G -Z auogdr - - f -4f 94v:y roS zo Q N wai3 }o aw>;N ,uoijoedsui sigl }o ejup eq} uo }oega ui suoilelnBei pue `seoueuipao 'sepoo 91BIS pue jedioiunw ale qj!m eoueildwoo ui si walsAs psodsip aa}emelsum ao/pue Alddns Jejum ajis-uo agj Uoijoedsui pue uoije6ijs9nui AW woaj pue sopj abujogouy jo AlpdioiunW eqj woaj pauielgo uoi}ewao}ui 9q1 uo peseq jeq} Ajiaanaaq:pnj I -uiejeq paleoipui ainjonjIs jo ads j pue swooapaq jo aagwnu aql ao} ejunbape pue leuoijouni'ejes si welsAs lesodsip Jejumalsem JO/pue Aiddns aalem alis-uo eqj jegl smogs uoileoildde Jenoaddy Aliaoglny gIlBGH sigj Jo uoije6ijsanui Aw legl ApJ9A I *019q unnogs ajep uoijepiJen aqj Jo se pue olaaaq paxilp jugs Aw Aq peigpoo sy H33NIJN3 A9 N01103dSNI :10 1N3W31VIS .9 Municipality of Anchorage Department of Health &Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: lerT 3A, gtAC1,_I f AtQ a_x_ Parcel I.D. A. WELL DATA Well type 1_34441K If A, B, or C, attach ADEC letter. ADEC water system number N LA Log present (Y/N) Date completed `- I / AL Driller W m_xni Swwn, Ate, r Total depth BD Cased to SO Casing height �• Z Sanitary seal (Y/N) 7' Wires properly protected (Y/N) y Date of test Static water level Well flow Pump level FROM WELL LOG 7% ZI18/ 8r S'0 g.p.m. AI/A SEPARATION DISTANCES FROM WELL TO: AT INSPECTION -7 8 9/ G • 9- p.m- Septic/holding tank on lot #0 ; On adjacent lots X00 -t- � r Absorption field on lot 1Z5 ; On adjacent lots _ ADD t Public sewer main tJ AA Public sewer manhole/cleanout ^J Public sewer service line A)/A Petroleum tank ^f 1A WATER SAMPLE RESULTS: Coliform S47•15),rANitrate Other bacteria Date of sample: LZ��9I Collected by: A404 B. SEPTIC/HOLDING TANK DATA Date installed ELZ qJ 8Z Tank size 17-SDIaAL • Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Y Depression (Y/N) High water alarm (Y/N) N Alarm tested (Y/N) ^% Date of pumping G Z6 /91 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /0 On adjacent lots Foundation r To property line ZV t Absorption field G Water main/service line Surface water/drainage AJ/A !4' R �J ,-JfA 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed — Manufacturer Size in gallons Vent (Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) Manhole/Access (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots "Pump off" level at Cycles tested Surface water Date installed SJZ�/� Z Soil rating System type ua�-p Length A f Width 3 ,Gravel thickness 4 IZ 1 Total depth -7 VZ � Total absorption area 378 FT. Z. Cleanouts present (Y/N) Depression over field (Y/N) A/ Date of adequacy test 7/,8 Results (pass/fail) PQ SS for Peroxide treatment (past 12 months) (Y/N) At 3 If yes, give date bedrooms SEPARATION DISTANCE FROM ABSORPTION FIELD TO: f Well on lot �Z �' On adjacent lots �0� 1 Property line /0 f 'N A To building foundation � To existing or abandoned system on lot On adjacent lots /00 / t Cutbank Water main/service line Ai 1A Surface water Al/h Driveway, parking/vehicle storage area /0 4 - Curtain drain N/A E. ENGINEER'S CERTIFICATION I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. 11 0 Signature L �'' • •••y�e® 49 A�4lf111b•YRi•a°i ct.r; Engineer's Name GFlAC'L ��11�L�SO� g���yyyggq .` •t.. "40 . luDate 7 5- V, W16,�,�Michael E. Anderson 6� g '�•. 4381- E <(.•••m�ftFEF HAA Fee $ 961, o Date of Payment Receipt Number 72-026 (Rev. 3/91) Back MOA 21 Waiver Fee: $ Date of Payment Receipt Number Q� CHEMICAL & GEOLOGICAL LABORATORY � A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561.5301 ANALISIS REPORT BT SIMPLE for WORKorder# 36295 Data Report Printed: JUL 19 91 t 10:50 Client Sample ID:1,31 11 AT ELLER PF'SID :U1 Ctllected JUL 11 91 4 07:00 his. REceived JUL 17 919 09:24 hrs. Pieeerved with :IS REQUIRED Client Name Client Acct SPO # Raq Ordered by :ROCEPORD CORP :ROCK[OR PO # NONE RECEIVED :MIKE ANDERSON l:alysis Completed :JUL 17 91 Send Reports to: L+.boratory Supe v1 or :ST N C. EDE I)ROCEEORD CORP Released By 2) .......ww...w.......w............ ...w ............... .ou................ a ........................................................... Chenlab Ref #: 91344B Lab Sapl ID: I Matrix: NATER AlloWahl• Parameter Tested Result Units Method Limits -•----------------------------------------------------------------------------------------------------- NITRATE-N 1.3 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE COLLECTED BY, MIKE ANDERSON. Remarks: •.w .................. 0 ................... ..www..•.... ..w.w.w........w.....w............ a ............. 1 Tuts Performed See Special Instructions Above UA -Unavailable ND. None Detected " See Sample Remarks Above. NA- Not Analyzed LT -Less Than. GT -Greater Than rte, SGS Member of the SGS Group (Soc*6 G6ndrale de Surveillance) z'.d V10 00000000000000000000 00000000000000000000 Lb:11 61-10-1661 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 3 BLock 1 Atelier Subdivision, T12N R2W Section 6 Location (address or directions) Chenega Drive (b) Applicant Name Dexter Smith Telephone: Home 333-1088 Business 344-4551 Applicant Address 9321 Atelier Anchorage 99501 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder Dy-, Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Alaska Pacific Mortgage Telephone Address 101 Benson Boulevard, Anchorage (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family Ekx Multi -Family ❑ Other Number of Bedrooms three (3) 3. WATER SUPPLY Individual Well F&kx Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite UxxPublic ❑ Community ❑ Holding Tank ❑ Note: It community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING 6ASPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm Address Date Telephone Engineer's Seal This Department has received written confirmation from the engineer, A.E.C.S., Inc,., regarding the Conditional Approval of May 15, 1986. The property has been brought into compliance and been re—inspected. Therefore, this property is now fully approved. 6. DHEP APPROVAL Approved for three (3) bedrooms by Approved xxxxxxxx Disa Terms of Conditional Approval Conditional CAUTION May 28, 1986 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 responsible4or errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/64) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 1. GENERAL INFORMATION 04 Application Date A-0 (a) Legal Description (include lot, block, subdivision, section, township, range) Location (address or directions) (b) Applicant Name ? 5A11,71-1 Telephone: Home -3 3-3- 1a15'17Business -�'7 ?` Applicant Address `VAI (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ; Buyer ❑ ; Other ❑ (explain); (d) Lending Institution Address (e) Address Telephone Real Estate Company and Agent �� (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single -Family Multi -Family ❑ Number of Bedrooms ~3 Other 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 the legality and status. 4. SEWAGE DISPOSAL Onsite Public ❑ Community ❑ 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(11i84) Z-3 /3/z/��' 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. _ Name of FirmC� Telephone s��o Address %��� /t% �3 1-41 Date 0� p4.j 5�/iA5 IAA `7",L'Csc%/l, 0 �; •+49TH •��yr A ;...•.• •..•o•..•o.•aO / P•.• 060 •• •• •foil ii : tea vc. aE�o, r e s 1g 8r$2§dal,. ti fit, AT AV 6. DHEP APPROVAL (�) Approved for55zbedrooms by �"' ate Approved _ Disapproved _ Conditional U Terms of Conditional ApprovalOF �`�'�-ems ��-•-^�Q ���'�'� �'��'-w-'2�'�--A' CAUTI O N 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) MUNICIPALITY OF Ah1CRW6t ALITY OF ANCHORAGE (MOA) MUNICIPALITY DEPT. OF HEAtt"LTH AUTHORITY APPROVAL (HAA) DEPT. OF�, 'k*WCKLIST - FEBRUARY 1984 ENVIRONMENT T&A• F HF,AjjFf„�, 264-4720 N GOT -3 MAY 1,j JLegal Description: 1Q d t IrTn"T D A. WEI� �I� Wk-EIVED Well Classification If A, D, C, D.E.C. Approved (Y/N) Well Log Present (yN) Date CompletedYield / / / Total Depth Xd Cased to Depth of Grouting A /g Static Water LevelPump Set At_ Casing Height Above Ground 1.7— Sanitary Seal on Casing (Y ) Electrical Wiring in Conduit) Depression Around Wellhead (YON Separation Distances from Well: / To Septic/Holding Tank on Lot ; On Adjoining Lots To Nearest Edge of Absorption field on Lot On Adjoining Lots t To Nearest Public Sewer Line / To Nearest Public Sewer / Cleanout/Manhole - ^% To Nearest Sewer Service Lienee on Lot Water Sample Collected byDate Water Sample Test Results -I�sF�T,2Y"' Comments B. SEPTIC/HOLDING TANK DATA Date Installed �?Size /2A �� No. of Compartments Standpipes Y V) Air -tight Caps(91N) Foundation Cleanout (iN) Depression over Tank (Y/Q Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well ��� To Building Foundation i i To Property Line - To Disposal Field To Water Main/Service eine // �'! Iq To Stream, Pond, Lake, or Major Drainage Course N�i4 Comments 1-3 5/ /tcralirZ C. ABSORPTION FIELD DATA Soils RatingAbsorption Strata Ay��*Y ' in p Type of System Design Date Installed 'Zs'��' Length of Field 1 � Width of Field Square Feet of Absorption Area Depression over Field (YN Results of Last Adequacy Test 3 Depth of Field 7S Visor Gravel Bed Thickness ' —377 Standpipes Present (Y0 Date of Last Adequacy Test ,tiA��_s� I"qQ 7_0144s Separation Distance from Absorption Field: To Water -Supply Well 1,4' To Property Line To Building Foundation Lot ; On Adioinina Lots To Water Main/Service Line /I To Cutbar k (if present) �✓/9 To Stream/Pond/Lake/or Major Drainage Course �� '0" i To Driveway, Parking Area, or Vehicle Storage Area Comments ,JE' ST�x%dP/I'E CkT OFF 34-400J 6ZOMAlb . C�A�my�t. '7o 444*7E IWb Ek77EA✓D . To Existing or Abandoned System on D. LIFT STATION Date Insta N Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Cycles during Adequacy Test. Meets MOA I certify that I h�eced, ver fied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed (�--� Date Company MOA No. tOF A4 �a�'�R� pep � Receipt No. O -! O�.�•: •°...°°°•°•�1� Date of Paymenta� • • iii .•..�i �d r ,•49' Amount: $ A........ gi ee�'s•Seah• 0 : LE Y C. REID, Ir 0 '�•. CE - 2251 ,yam® Page 2 of 2 +'� ��,,�'°•....••°,•+`~'4r� 72-026 (11/84) ALASKA CI N1R0WnTAL COnTROL SRuIRS, InC. Engineerinq & enuironmental Studies May 22, 1986 To: Whom it May Concern Dexter Smith has located and extended to above ground the standpipe at the end of the trench located on Lot 3, Block 1, Atellier Subdivision. This would meet the minor conditional placed on the Health Authority. Sincerely, Leroy Reid Jr., hD., PE Pres' ent GAIMN 9WLZAN , NOUDRON 1d1NIV4NC 41 AN3 R H11V3H dO 140 ORNORMr Apr AuuW44 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (907) 561-5040 ALASKA 61 JUMPTAL COnTROL SekuI S, InC. 6ngineerinq & 6nuironmental Studies DEXTER SMITH 9321 ATTELIER ANCHORAGE AK 99501 60171 05/07/86 SELLER—DEXTER SMITH DEXTER SMITH 9321 ATTELIER ANCHORAGE AK 99501 LEGAL:ATELLIER SUBDIVISION BLOCK 1 LOT 3 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE -05/07/86 THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF 37.8 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 926 GALLONS. BASED UPON THE TEST DATA THE SYSTEM-7'S—ACCEPTABLE FOR A 3 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 04/30/86 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW TEST ON WELL WELL FLOW DATE -05/07/86 A FLOW TEST WAS PERFORMED ON THE WELL. 926 GALLONS OF WATER WAS PUMPED AT A RATE OF 6.6 GPM OVER A DURATION OF 2.3 HOURS. THE DRAWDOWN WAS 2.2 ' WITH A RECOVERY TIME OF 10 MINUTES AND THE STATIC WATER LEVEL WAS 49 FEET. THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME. 0 A4 sir.TH ,irA i ROY C. REID, JR. CE - 2251 -4P .e •�. I 4 14% s 1200 West 33rd Auenue, Suite B • Anchorage, Alaska 99503 • (907) 561-5040 as Time APPLF NT FILLS OUT UPPER HA ONLY Property Ownar ,x ,D e. K C')e F s m / 7tA Phone Mailing Addrsss8.;2Zip 4 Code" —i L a Buyer Address / ' - J/)fit C tu- Zip Code Lending InstitutionrJ Phone Address Zip Code Inspector Realty Co. & Agent Inspecto OLrviv��i Phone-. Address Zip Code Legal Description �✓1 f� �� ��� fed �! �tC,s'} Street Location( i Type of Residence 2-2 1932 Single Family ❑ Multiple Family No. of Bedrooms ❑ Other RECEIVED Water Supply V Individual a. Li(o'f4 ATTACH WELL LOG. A well log is required for all w*Is drilled since June 1975. ❑ Community //° For wells drilled prior to that date, give well depth (attach. log if available). ❑ Public Utility Sewer isposal (� n Cy Individual Year Individual Installed: ❑ Public Utility When Connected to Public Utility: 1 ❑ Holding Tank C) - NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time ,, Time —i L a Date Date Date - \ �) Date 1 Inspector Inspector Inspector Inspecto OLrviv��i irn�u i v -,JC ORAGE Field Notes: DFPT C.r 2-2 1932 - - RECEIVED ( 3) APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( DISAPPROVED ( ►CONDITIONAL APPROVAL' DATE Z 12 �B BY:` Com' Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank 72023 (3182) October 27, 1982 Dexter F. Smith 9321 Ateliar Anchorage, AK. 99504 Subject: Lot 3 Block 1 Ateliar Subdivision Approval for the individual sewer and water facilities cannot be chanted until the following items have been completed: ° Exposed electrical. wires to the well head are in violation of the Municipality of Anchorage codes and must be encased in conduit. • The water analysis report needs to be submitted to this office from the Chem Lab, 5633 8 Street, for our review. Please notify this Department for a reinspection when the noted discrepancies have been corrected. if there are any further questions, please call this office at 264-4720. Sincerely, Ler, Buchholz Program Supervisor LP l % p/ EE3