HomeMy WebLinkAboutBEAR VALLEY BLK 4 LT 3Bear Valley Block 4 Lot 3 #020-431-22 inspection Keport-i-i-iz.coc Municipality of Anchorage Community Development Department Page 1 of 3 On-Site Water and Wastewater Program 4700 Elmore St. - P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP131305 PID Number: 020-431-22 ❑ New ❑✓ Upgrade Name: James & Jean Dore ABSORPTION FIELD ❑Deep Trench ED Shallow Trench ❑Bed El Mound Address 9251 Snow Bear Drive ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 0.8GPD/SF - 6Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1 Ft. I Gravel depth beneath pipe 4Ft. Subdivision Block Lot Bear Valley 4 3 Fill added above original grade 2 Ft, Gravel length 60 Ft. Township Range Section Gravel width 5Ft. Beds: Number of Lines Distance between lines I Ft. SEPARATION DISTANCES To Septic Absorption Lift Station Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 600 Ft2 1 N/A Ft. Well 108.8 137.4 N/A NIA 82.5 TANK ❑ Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer Anchorage Tank Capacity 1000Gal. Surface Water 285.0 239.3 N/A N/A Material Number of compartments Lot Line 77.4+ 33.0 N/A N/A Steel 2 NA Foundation 63.4 99.1 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain N/A N/A N/A N/A Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to d a afield 3034 Beek's Construction Drainfleld 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 100ft Inspection dates: V g/30/2014 z 10/1/2014 Location and description 3I n`" Corner of house trim COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's stamp 420_ NAL,k �, Conditional Approval: Date ........ � ..:.— ro 1even ail CE 8149,E �,� ��� lCp.► A roved PP Datey //Jy4���'► inspection Keport-i-i-iz.coc 41 FC 29.4 13.9 TI 69.6 66.7 T2 74,9 72.8 DCO2 777 76.0 10' UTILITY EASEM�!� 110.1 101.7 137.4 20' UTILITY EASEMENT IA XTEJNDED EXISTING EPHEMERAL 4" FOUNDATION DRAIN DISCHARGE VV PIPE DOVVNHILL FROM DRAIN FIELD W� INTO DRAINAGE EASEMENT, 25' BELOW DRAIN FIELD TH —SEPTIC A M_ DRAIN HELD (N) DRAIN FIELD (E) REUSE AS RESERVE CCO 1 &,2\ FCLNCJION DRAIN PIPE (E) 108.8 1 000g SEPTIC TANK (E) WELL (EN) OT 3 ABANDONED PER CODE IOUC)g SEPTIC TANK (W PLAN 3BR HOUSE SNOW -------------- PANNONE ENG SVC, LLC P.O. BOX 100217 PHONE (907) 272-8218 ANCHORAGE, AK FAX (907) 272-8211 BEAR VALLEY, BLOCK 4' LOT 3 JAMES & JEAN DURE 9251 SNOW BEAR DRIVE ANCH0RAGE, AK 09516 020-431-22 Ponnope PERMIT NO SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION WAS 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 WASTEWATER DISPOSAL SYSTEMS. 3. SCOPE OF WORK: INSTALLED NEW I OOOg SEPTIC TANK AND SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS NOT ENCOUNTERED BELOW EXISTING GRADE IN ANY OF THE EXCAVATIONS LESS THAN 9.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMETIATLY. ELEV.90 1000 g SE TANK (N) LEGEND W WATER LINE/ WELL RADIUS SS NOTES: RECORD DRAWING NEW SEPTIC DESIGN DETAILS ILE DESIGN PARAMETERS RESER`✓E SEPTIC SYSTEM N0, BEDROCTD: L (450 gpd) TANK SI_E 10d1'g PERC R- TE = 5.2 MPI SOIL RATING: 0.8 GPD/SF AREA ROD: 562.5 SF SYS. TYPE: WIDE TRENCH 4.0'ED RF: 0.50 MIN LENGTH: 56.25 LF USED: 58.5 LF X 5.0' WIDE, 4.0' E.D., 5.0' TD TOTAL AREA: 600 SF PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 BEAR VALLEY, BLOCK 4, LOT 3 JAMES & JEAN DORE 9251 SNOW BEAR DRIVE ANCHORAGE, AK 99516 ROCK ABBREVIATIONS CU rTS& V MOUND DIP DUCTILE IRON PIPE TH —2" RIGID INSULATION FC FOUNDATION CLEAN OUT Taj FILTER FABRIC C# CLEAN OUT N0. M� —4" 0 DRAIN PIPE R.I. RIGID INSULATION DCO DRAIN ROCK 6" ABOVE PIPE INV DV DIVERTER VALVE FS _ i I ELEV.91.6 BFG BELOW FINISH GRADE TH-1 2S j FG FINISH GRADE TS&V OR 1 J— --' TOP ELEV. 89.46 0.o INV. ELEV. 89. 116 6 40 N DRAIN ROCK IN D. ELEV. 85.1 J�er „M 10/2/2013 91.0 ECTION 6 ELE!'Q RIGID INSULATION m z/ a FILTER FABRIC j w 4" 2 DRAIN PIPE z 1 FDRAIN ROCK 6" u n n 1 II ABOVE PIPE INV (� ELEv91.6 1000 g SE TANK (N) LEGEND W WATER LINE/ WELL RADIUS SS NOTES: RECORD DRAWING NEW SEPTIC DESIGN DETAILS ILE DESIGN PARAMETERS RESER`✓E SEPTIC SYSTEM N0, BEDROCTD: L (450 gpd) TANK SI_E 10d1'g PERC R- TE = 5.2 MPI SOIL RATING: 0.8 GPD/SF AREA ROD: 562.5 SF SYS. TYPE: WIDE TRENCH 4.0'ED RF: 0.50 MIN LENGTH: 56.25 LF USED: 58.5 LF X 5.0' WIDE, 4.0' E.D., 5.0' TD TOTAL AREA: 600 SF PANNONE ENG SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 BEAR VALLEY, BLOCK 4, LOT 3 JAMES & JEAN DORE 9251 SNOW BEAR DRIVE ANCHORAGE, AK 99516 ROCK ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT Taj TcANK CLEAN OUT N0, C# CLEAN OUT N0. M� MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE 1/7/2015 *IJ NTS P.LO. NO I' 020-431-22 Steven R: Pon none PERMIT NO. CE 8149 OSPI31305 (�l��PRO ssioeP�— Sheet h3eOF 3 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: OSP131305 Tax Code Number: 02043122000 Work Type: Septic Permit Effective Dates: October 21, 2013 to October 21, 2014 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: BEAR VALLEY Site Legal Address: BEAR VALLEY BLK 4 LT 3 G:3242 Owner/Address: DORE JAMES C & JEAN M PO BOX 113171 ANCHORAGE AK 995113171 Site Mailing Address: 9251 SNOW BEAR DR, Anchorage This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Lot Size in Sq Ft: 49069 Total Bedrooms: 3 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 MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 020-431-22 Property owner(s) James & Jean Dore Mailing address P.O. Box 113171, Anchorage, AK 99511 Day phone Site address 9251 Snow Bear Drive Legal description (Sub'd., Block & Lot) Bear Valley, Block 4, Lot 3 Legal description (Township, Range & Section) Lot Size 49,069 Sq. Ft. APPLICATION IS FOR: (E all that apply) Absorption Field ❑X Septic Tank ❑X Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms 3 APPLICATION IS AN: TYPE OF DWELLING: Initial ❑ Single Family (SF) ❑X (w/wo ADU) Upgrade ❑x Duplex (D) El ❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: 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: - Date of Payment: �J Receipt Number: 0%0Q rA Permit No. O`)P 1 31;yu5' Permit App__- :.:'-.,:c Waiver Fees: Date of Payment: Receipt Number: Waiver No. Pannone Engineering Services uc Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve(aoanenzak.com August 30, 2013 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road P. 0. Box 196650 Anchorage, Alaska 99519 Subject: Bear Valley, Block 4, Lot 3 Septic System Upgrade Permit Request Ladies and Gentlemen: I am writing to request a permit to install an upgrade septic system be issued for this property. The proposed systems will serve an existing three (3) bedroom house. Currently the lot is developed. The existing field is in failure and will be reused as a reserve. The existing 1000g tank will be abandoned per code. This lot is served by a private well that is located over 100' from the proposed septic system. The surrounding lots are also served by private wells that are over 100' from this system. 1. Soils: One test hole was excavated in the area of this drain filed by Pannone Engineering Services in August of 2013, and groundwater was not encountered in the test hole. It is my opinion, based on the results of the percolation tests and overall soils appearance; an application rate of 0.8 gallons/day/square feet should be used for a conventional wastewater system. 2. Soil Absorption System Design. a. See Sheet 2 of the design package. 3. 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. 4. Topography: The existing topography slopes from the south to north at approximately 15% in the area of the proposed drain field. There are no steep slopes in the vicinity of this system. S. 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 Department, the note will be removed and "Issued for Construction" drawings will be issued. 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 The proposed installation will not affect the future development of the surrounding or existing lots. There are no surrounding wells within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments 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 SEPTIC A EA (E) 10' UTILITY EASEMENT 10' UTILITY' EASEMENT 199.4 105.2 TO CREEK EXTEND EXISTING EPHEMERAL 4" FOUNDATION DRAIN DISCHARGE PIPE DOWNHILL FROM DRAIN FIELD INTO DRAINAGE EASEMENT, 20' UTILITY EASEMENT 25' BELOW DRAIN FIELD 39.7 ss /41 EPTIC AREA (E) DRAIN FIELD (P) DRAIN FIELD (E) FOUNDATION DRAIN PIPE (E) IN FAILURE REUSE AS RESERVE ABANDON PER CODE 1 OOOg SEPTIC TANK (P) LOT 3, D "',�``"' JBRHOUS[ ([) NOTES: CONSTRUCTION SNO DOG/ 1e3 2 0 13 PHONE (907) 272-8218 FAX (907) 272-8211 Awo?�. Scale BEAR VALLEY, BLOCK 4, LOT 3 JAMES 8c JEAN D0RE 9251 SNOW BEAR DRIVE ANCHORAGE, AK 99516 �� 020-431-22 PERMIT NO. CE 8149 OSP1 31305 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 WASTEWATER DISPOSAL SYSTEMS. 3. SCOPE OF WORK: INSTALL NEW 1000g SEPTIC TANK AND SOIL ABSORPTION SYSTEM. 4. GROUNDWATER WAS ENCOUNTERED AT 9.0 FEET BELOW EXISTING GRADE AS EVIDENCED BY THE SOIL TEST HOLE. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 9.0 FEET BELOW EXISTING GRADE NOTIFY THE ENGINEER IMMETIATLY. TH-1 3 ?S -W MevtAd C* a..,a M ROCK 6" ABOVE PIPE INV 1000 g SE TANK (P) LEGEND W WATER LINE/ WELL RADIUS SS — NEW SEPTIC PROFILE DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g PERC RATE = 5.2 MPI SOIL RATING: 0.8 GPD/SF AREA ROD: 562.5 SF SYS. TYPE: WIDE TRENCH 4.0'ED RF: 0.50 MIN LENGTH: 56.25 LF USE: 60 LF X 5.0' WIDE, 4.0' E.D., 5.0' TO TOTAL AREA: 600 SF ROCK ABBREVIATIONS CU COPPER `DRAIN ROCK DUCTILE IRON PIPE TH GM 4.0 FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS 10!2!2013 BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG SECTION TS&V TOPSOIL & VEGETATE _130 w N� <o J 0 J J 0 0 <, W m W m z o o FILTER FABRIC o z z Z r Z IiU U U DU w 0 0 DRAIN PIPE z llr�ABOVE z �I1� �nIrI �II�I��lnIlI -1�I7LI Q 1 0 DRAIN ROCK 6" PIPE INV n n 0 1000 g SE TANK (P) LEGEND W WATER LINE/ WELL RADIUS SS — NEW SEPTIC PROFILE DESIGN PARAMETERS RESERVE SEPTIC SYSTEM NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1000g PERC RATE = 5.2 MPI SOIL RATING: 0.8 GPD/SF AREA ROD: 562.5 SF SYS. TYPE: WIDE TRENCH 4.0'ED RF: 0.50 MIN LENGTH: 56.25 LF USE: 60 LF X 5.0' WIDE, 4.0' E.D., 5.0' TO TOTAL AREA: 600 SF ROCK ABBREVIATIONS CU COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. M# MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER BFG BELOW FINISH GRADE OG ORIGINAL GRADE FG FINISH GRADE TS&V TOPSOIL & VEGETATE NOTES:PAMONE ENG SVC, LLC � Date FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 �'(rG OF A�gslll 0/16/2013 PHONE (907) 272-8218 FAX (907) 272-8211 /�g�P �.y++ Scale *: .*�, NTS .... ... P.I.D. NO BEAR VALLEY, BLOCK 4, LOT 3... 020-431-22 JAMES & JEAN DORE / 5teven R. an -e / PERMIT NO. 9251 SNOW BEAR DRIVE 'f'�s. CE 8149 \�� OSP131305 DESIGN DETAILS ANCHORAGE, AK 995161` �!'' ••• ''� Sheet FROFESSIONP s 2 OF 3 TEST HOLE 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 - ORGANICS SILTY GRAVEL DATE PERFORMED: 8/22/13 10/2/2013 SOILS LOG - PERCOLATION TEST SLOPE X TH WAS GROUND WATER ENCOUNTERED? N IF YES, AT WHAT DEPTH? DEPTH TO WATER AFTER MONITORING? -9.0' DATE: 10/2/2013 SLOPE TH X READING DATE CLOCK NETTIME WATERTIME LEVEL READING NET DROP 1 8122/13 10:30 - 3.92 - 2 10:40 10 MIN 6.02 2.10 3 10:40 - 3.92 - 4 10:50 10 MIN 5.86 1.94 5 10:50 - 3.92 - 6 11:00 10 MIN 5.86 1.94 PEROLATION RATE 5.2 (min/inch) PERC HOLE DIAMETER 6Inches TEST RUN BETWEEN 4 FT AND 5 FT COMMENTS: Test hole excavated by BEEKS CONTRACTING. Pere hole was presoaked. Test was run for at least one hour. Last three readings reported. PERFORMED BY: Steven R. Pannone, P.E. I CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPA�L�GT7UIIDL7IIN�E+S �I7N�7EFFECCT'ON THE �DATE OF THIS TEST. NOTES: PC11`IlVOl\L' I�LVG JYC1 LW ���" I Date FOR CONSTRUCTION P.O. BOX 100217 ANCHORAGE, AK 99510 c��F ALgsll� 0/16/2013 PHONE (907) 272-8218 FAX (907) 272-8211 /�aj�P �y1f Scale BEAR VALLEY, BLOCK 4, LOT 3 JAMES & JEAN DORE 9251 SNOW BEAR DRIVE SOILS LOG ANCHORAGE, AK 99516 *:• TH Ir NTS ..... ... ... ... P.I.D. NO .,,,, ••, ,,,,, 020-431-2z Steven R. onn,.e.w PERMIT N0. CE 8149 j OSP131305 Sheet3 OF 3 iz-uis Ulev.3/M) UK 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 0 3Yy 9 80 UPGRADE MAILING ADDRESS Ili is 51 C_- J0" *f— I l -T fiI S p bra 11 LEGAL DESCRIPTION 7 Bear v xiie L-ot 3 p ee 8 (� � y ' TuAl 4 � L" LOCATION S NO. OF BEDROOMS 0� Be-t� .3 DISTANCE TO: WellAbsorption l I O area Dwelling -- PERMIT NO. aq) 8 U y .5- n' I A g 0� w< Manufacturer are- Re- Material .9,i _ _ i No. of compartments I- fn Liq. capacity in gallons 1000 IF HOMEMADE: Inside length Width Liquid depth y DISTANCE TO: Well Dwelling PERMIT NO. J(DZ O Z H Manufacturer Material Liquid capacity in gallons J = W DISTANCE TO: Well ( 6 Foundation np �- ►"n Nearest lot line 33 PERMIT N c �o �� LL z No. of lines ' Length of each line Total length of lines Trench wi Distance between lines FZW O inches --� ` I_ Top of tile to finish grade Material beneath ti(e' Total effective aption area D inches Length Width Depth _ PERMIT NO. W 0 a F- Wa Type of crib Crib diameter Crib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. J W DISTANCE TO: Building foundation Sewer line r �z Septic tank/ j©s r Absorption area(s) OTHER ec, ie PIPE MATERIALS SOIL TEST RATING 9-o017 I-NSTALLER De Arn, 0-") T' `i REMARKS ok- STA 02� 3 e ti 3 v' t Mre S(!r a APPROVED DATE LEGAL -r/f iu Via, � J v,: I c f. a v it's � �. � +� o par 1/411-eL, f- 3 i lu r- 1- iz-uis Ulev.3/M) UK PERMIT NO: DATE ISSUEDg APPLICANT: ADDRESS: CONTACT PHONE: v ��J PA I C: I F --"#'-N L_I "'T'"V �3 F -- - f -N P4 C:� 9-1 C3 F:;t 0=� C-3 FEZ . DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L STREET, ANCHORAGE, AK 99501 264-4720 0 P%J_E; I *T- En E3 R h4 EE FR Fz" EE FZ IM I IF W 840709 08/20/84 J. T. HOGUE 1551 ELCADORE #117 ANCHORAGE, AK 99501 344-7B01 LEGAL DESCRIP: SUBDIVISION: BEAR VACLEY LOT: 3 SECTION: 6 TOWNSHIP: 11N RANGE: 2W LOT SIZE: 49069 (SQ.FT. OR ACRES) ` MAX BEDROOMS: 3 BLOCK: 4 Listed below are the options available to you in designing your septic system. Choose the option that best {its your site. ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ... ... ... ..... ___ I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by -the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOAcodes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AG-BUILTS WILL NOT BE APPROVED WITHOUT' AN ELECTRICAL INSPECTION REPORT: AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SI8NED APPLICANT: ) ISSUED BY _________________���__ DATE: / DATE: IF FT E= PA C1 VA ]I[:-: r F -Z E) V4~ 01 FZ. r --h 1: P4' DEPTH TO PIPE BOTTOM (FT.) 4.0 4.0 4.0 GRAVEL DEPTH (FT.) 6.5 0.5 ^ 3.5 TOTAL DEPTH (FT.) 10.5 4.5 7.5 GRAVEL WIDTH (FT.) 2^5 22.0 5.0 GRAVEL LENGTH (FT.) 47.0 41.0 65.0 GRAVEL VOLUME (CU.YDS.) 30.4 33.4 48.1 TANK SIZE (GALS) 1r000.0 ** 1,000.0 ** 1,000.0 ** SOIL RATING (GQ.FT./BR) 200 197 200 ** TANK MUST HAVE AT LEAST TWO COMPARTMENTS ... ... ... ..... ___ I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by -the Municipality of Anchorage (MOA) and the State of Alaska. 2. I will install the system in accordance with all MOAcodes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for a maximum of 3 bedrooms and any enlargement will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AG-BUILTS WILL NOT BE APPROVED WITHOUT' AN ELECTRICAL INSPECTION REPORT: AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SI8NED APPLICANT: ) ISSUED BY _________________���__ DATE: / DATE: SOILS LOG 'e MUNICIPALITY OF ANCHORAGE 0 DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST PERCOLATION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERFORMED FOR: � �2DG�-i�Z C-�1J C71?� DATE PERFORMED: 3z.Ji z LEGAL DESCRIPTION:&Rc YaJiey A>4 I„] lock SLOPE SITE PLAN PERFORMED BY: 8 (6/79) GIV�� rocky syG -from- a � CSM �iify „vvS �C_ mom y 8 «m9 brow L s`/Ly s4"1 WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? (� i , t I; n Reading Date Gross Time Net Depth to Time Water Net Drop 2'3 -Z• -^ Lo '2- Ll 2,_y2 2<$Z• 102, !vv • / b bo .� !o PERCOLATION RATE hOq Sf �yDay CERTIFIED BY: d'tPU -/v Io (% —(minutes/inch) 5 FT 1 ALASKA OI", M11M611TAL C011TROL SCRL' ��� Inc, Engineering 6 Enuironmental Studies PERCOLATION TEST DATA SHEET CLIENTZ�xrc ✓ DATE✓%G 2 ADDRESS ZI P CODE LEGAL LOCATION G .31vc- I /tee —' "- tA� TOTAL DEPTH OF HOLE / S� ft. ZONE TESTED �� ft TO Z` ft TH # -rJ4 TEST HOLE DIAMETER d READING # CLOCK TIME NET TIME DEPTH TO DATUM NET DROP RATE (min/in) -2yi 3v/ '3 S^ — 3 1 r �- 3• ► � � 1 5 L; �-y FINAL PERCOLATION RATE 5-7 -06 (min/i n ) 3-5) SQUARE FOOT/BEDROOM PERFORMED BY MOA STBN-024 1200 U6t 33rd Aut we Suw14• Anchorage, Alaska 99503 (907) 276-1361 (L- 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 C(a,-aatl. Secy) \T 0 ;maze r N WAS GROUND WATER S ENCOUNTERED? _J�pj L O P IF YES, AT WHAT E C\ DEPTH? \ t" Reading Date Gross Time L-_ SOILS LOG Depth to Water MI��� „ ,I � •,- n��C�InRAGF MUNICIPALITY OF ANCHORAGE ,1' � _ u ►..rC DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECT�t)N" " P' '" ''`PERCOLATION TEST 825 L. Street, Anchorage, Alaska 99501 264-4720 I I--- SOILS LOG - PERCOLATION TEST RECEIVL" L) PERFORMED FOR: �ttr�i� Mt ems_ DATE PERFORMED: G — `0 LEGAL DESCRIPTION:) nr s�3 Q1K �i �PC7 i 11t���YJ X007, DEPTH SLOPE SITE PLAN 1 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 C(a,-aatl. Secy) \T 0 ;maze r N WAS GROUND WATER S ENCOUNTERED? _J�pj L O P IF YES, AT WHAT E C\ DEPTH? \ t" Reading Date Gross Time Net Time Depth to Water Net Drop I I--- ---I O L� PERCOLATION RATE .-; �r (rninutes/inch) I TEST RUN BETWEEN S_ - FT AND 'Z / FT COMMENTS , .ztC----- PERFORMED BY: e)c � _� rn; K,_P__ _CERTIFIED BY: 72-008 (6/79) _ DATE: 1/1 0'� Parcel I.D. # MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services M DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 020 431 22 000 HAA # ',A(-A`� :� ;, i, (L'! 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) L3, B4, Bear Valley Subdivision Location (address or directions) 9251 Snowbear Drive (b) Property owner Kent Nunberg Telephone: (home) 345-6103 Business 659-2805 Mailing Address 9251 Snowbear DryaAncborage, AK (c) Lending Institution unk• Telephone Mailing Address (d) Real Estate Company and Agent Merilyn Moore Re/Max Address 2600 Cerdd)va St. Ste 100, Anchorage, AK 99503 Telephone 276-2761 (e) Mail the HAA to the following address: (or check here ❑, if hold for pick up.) List contact person and day phone number below: i 2. TYPE OF RESIDENCE Single -Family 3. WATER SUPPLY �] Number of bedrooms 3 \, 1i q I V1 (-.'e' C.- -72 Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm CL tori in Al aska Fngi nPPrG Telephone X49-1 nn� Address P_n_ Box 111790 AnrhnracrrP, AK 99511 1790 Date nen-mhczr. 1 R . 19 9 2 _ o � 7 Engineer's Seal 6. DHHS APPROVAL Approved for J bedrooms by 0 rr N &,1, Date Approved Disapproved Conditional Terms of Conditional', Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engin'eer's work. 72-025 (Rev. nea) Back Page 2 of 2 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L3, B4, Bear Valley Parcel I.D. 020 431 22 000 A. WELL DATA Well type Private If A, B, or C, attach ADEC letter. ADEC water system number _ Log present (Y/N) Ne Date completed uR44gwn Driller Total depth 151 , Cased to 40 Casing height 1.1' Sanitary seal (Y/N) Wires properly protected (Y/N) Public sewer service line WATER SAMPLE RESULTS: Coliform N Petroleum tank mone Nitrate 2.2mg/1 Other bacteria 0 Date of sample: 12./4./92 k l2,/R,/q2 . Collected by: Thpcxjrm� A - -Tc)nhnC;(-)n.F P- F- B. SEPTIC/HOLDING TANK DATA DateyyVgged 8/22/84 Tank size1888 Compartments Cleanouts (Y/N) Yes Foundation cleanout (Y/N) Yes Depression (Y/N) No High water alarm (Y/N) Date of pumping 9/5/91 Alarm tested (Y/N) R/a SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot 18g., On adjacent lots 1004- Foundation 65 To property line 7-4 Absorption field Water main/service line 65+ Surface water/drainage 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE z221 FROM WELL LOG AT INSPECTION -1 Z Date of test 12/4/92 -v Static water level 37 Well flow g.p.m. 4'0 rM g.p.m. 00 ,_. m < > Pump level 116 r M CA C SEPARATION DISTANCES FROM WELL TO: N z Septic/holding tank on lot 105' ; On adjacent lots 100+ Absorption field on lot 419 ; On adjacent lots Public sewer main n/a Public sewer manhole/cleanout n/a Public sewer service line WATER SAMPLE RESULTS: Coliform N Petroleum tank mone Nitrate 2.2mg/1 Other bacteria 0 Date of sample: 12./4./92 k l2,/R,/q2 . Collected by: Thpcxjrm� A - -Tc)nhnC;(-)n.F P- F- B. SEPTIC/HOLDING TANK DATA DateyyVgged 8/22/84 Tank size1888 Compartments Cleanouts (Y/N) Yes Foundation cleanout (Y/N) Yes Depression (Y/N) No High water alarm (Y/N) Date of pumping 9/5/91 Alarm tested (Y/N) R/a SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Wells) on lot 18g., On adjacent lots 1004- Foundation 65 To property line 7-4 Absorption field Water main/service line 65+ Surface water/drainage 72-026 (Rev. 3/91) Front MOA 21 CONTINUED ON BACK PAGE C. LIFT STATION Date installed — n/4 Manufacturer Size in gallons Vent(Y/N) "Pump on" level at Manhole/Access (Y/N) High water alarm level Meets MOA electrical ''codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots D. ABSORPTION FIELD DATA Date installed 8/22/84 Soil rating "Pump off" level at — Cycles tested Surface water 200 System type e Length 49' Width 2.5 Gravel thickness 6.5' Total absorption area 650 qf Cleanouts present (Y/N) Depression over field (Y/N) No -Total depth 10.7' Yes Date of adequacy test 12/4/92 Results (pass/fail) Pass for i-• •• Peroxide treatment (past 12 months) (Y/N) No If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 110' On adjacent lots 100+ Property line 22' To building foundation 75' To existing or abandoned system on lot n/a On adjacent lots 40* Cutbank _n/a Water main/service line n/a Surface water n/a Driveway, parking/vehicle storage area Curtain drain n/a E. ENGINEER'S CERTIFICATION 70+ L.-. ..11 ! certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. g Signatu F Engineer's N me 6-40.1� `�- 0;1 r � ��'• � �® Date .. .........o -,` Theo m A. Johnson ;,40;4 CE 5191 HAA Fee $ /70 Waiver Fee: $ Date of Payment Date of Payment Receipt Number Z-=7 • S:Z,d Receipt Number 72-026 (Rev. 3/91) Back MOA 21 CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FAX: (907) 561-5301 ANALYSIS RESULTS for INVOICE # 61422 Chemlab Ref.# 92.6734 Sample # 1 Matrix: WATER Client Sample ID L3 B4 BEAR VALLEY PWSID UA Collected 12/03/92 @ 10:30 hrs. Received 12/08/92 @ 16:55 his. Preserved with Analysis Completed 12/09/92 Laboratory Supe vi o : EPHEN C. EDE Released By : e tVED/DE' Client Name :CRITERIUM AK ENGR Client Acct :CRITERI BPO# Req# Ordered By :TED JOHNSON Send Reports to: 1)CRITERIUM AK ENGR 2) PO# :NONE RECEIVED .................................................................................................................................... Parameter ------------------------------------------------------------------------------------------------------------------------------------ Results Units Method Allowable Limits NITRATE-N 2.2 mq/l EPA 353.2/300.0 10 Sample ROUTINE SAMPLE COLLECTED BY: T.N. Remarks: .................................................................................................................................... 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected "" See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than AVIISGS Member of the SGS Group (Soci6t6 G6n6rale de Surveillance) MUNICIPALITY OF ANCHORAGE • Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 6>Z0 _iT -22 HAA # // 6 "8-'o / 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, 3 on, township, range)_ r 7—//,)97,A Location (address or directions), gzSl :Sri gem (b) Property owner xfi�J�r.. Telephone: (home) Business 7t!7G —SS99 Mailing Address - °X /a'/M "�') % %S o (c) Lending Institution Mailin Address Telephone 9 -3-1, b / u D 7?-, (d) Real Estate Company and Agent �EHR-k Address Z_&M ev eboVA Telephone 7,7to-4761 (e) Mail the HAA to the following address: (or check here`Z, if hold for pick up.) List contact person and day phone number below - 14r -e- S z'7 9 -ss�o 2. TYPE OF RESIDENCE Single -Family Number of bedrooms 3 3. WATER SUPPLY Individual Well`k Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 5. ENGINEERING FIRM, PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinandes, and regulations in effect on the date of this inspection. Name of Firm g�CS Telephone y7 Address /5�y 33Jctr %iso Date // Vd I 10;04&W%r► Q Af 0,�� o 'to o• f/ .t.aN• • •.0000•••.•000••.Li, 0 : ROY C. REIN, JR. I,• CE .2251 alf + •�.• O 0*04,00 6. DHHS APPROVAL Approved for 3 bedrooms by Date Approved Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72-025 (Rev. 7/88) Back Page 2 of 2 A. WL DATA B Well Classification MUNICIPALITY OF ANCHORAGE (MOA) • Health Authority Approval (HAA) CHECKLIST - FEBRUARY 1984 343-4744 ?,ei Vh-re- Legal Description: Lo7-3 Da 7" /364- * ol/zeel T/.J Z 2- ,&J 5W?-- 6 If A, B, C, D.E.C. Approved (Y/N) Well Log Present (YA Date Completed 6t•.t1,C',i4 Yield 3' / 6P�l Total Dept®— Cased tF__'�_Ot Depth of Grouting /¢ i Static Water Level x� Pump Set At Casing Height Above Ground — Electrical Wiring in Conduit N) SEPARATION DISTANCES FROM WELL: / 3S" Sanitary Seal on Casing&Y N) Depression Around Wellhead (Y�I To Septic/Holding Tank on Lot I10.S ; On Adjoining Lots led To Nearest Edge of Absorption Field on Lot P6 ; On Adjoining Lots Ovo To Nearest Public Sewer Line A14 To Nearest Public Sewer Cleanout/Manhole A) 11-4 i To Nearest Sewer Service Line on Lot fi Water Sample Collected by _/"f /4'•iE� ; Date Water Sample Test Results Ade T Comments rF-0 Ai7iM44b 19-JU&es SEPTIC/HOLDING TANI DATA Date Installed 8Size �� No. of Compartments Z_ StandpipeseYN) Air -tight Caps aY ) Foundation Cleanout�/Y N) Depression over Tank (Y/© Date Last Pumped 11_5�11` Pumping/Maintena,nce Contact on File (Y/N) d LK ; for IJ14 Holding.Tank High-Weter Alarm (Y/N) W-141 Temporary Holding Tank Permit (Y/N) SEPARATION bISTANCE8 rROM SEPTIC/HOLDING TANK: To Water -Supply Well 11v -To Building Foundation s fob ;A - To Property Liner 7Y To Water Main/Service Line_; /0 'y To Stream, Pond Lake or-Oajor Drainage Course Comments ` To Disposal Field / 72-026 (Rev. 7/88) Front Page 1 of 2 4-3 * MW C. ABSORPTION FIELD DATA To Building Foundation /46 To Existing or Abandoned System on Lot 0 /k ; On Adjoining Lots �t_ To Water Main/Service Line of To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course i To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION i D'ItLstalled Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) *`Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and inspection. Signed CompanyG� Soils Rating in Absorption Strata Type of System Design Date Installed "Z2 --W Length of Field i9 Width of Field 7-15 Depth of Field Gravel Bed Thickness Square Feet of Absortion Area rioj 7 Statndpipes Present6)N) Depression over Field (Y N Date of Last Adequacy Test Results of Last Adequacy Test 140MA12' SEPARATION DISTANCE FROM ABSORPTION FIELD: , To Water -Supply Well 116 To Property Line 3� To Building Foundation /46 To Existing or Abandoned System on Lot 0 /k ; On Adjoining Lots �t_ To Water Main/Service Line of To Cutback (if present) To Stream, Pond, Lake, or Major Drainage Course i To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION i D'ItLstalled Dimensions Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) *`Check Permitted Bedroom Rating Against HAA Request" I certify that I have checked, verified, or conformed to all MOA and inspection. Signed CompanyG� Date 11'3! " MOA No. Pumping Cycles during Adequacy Test. HAA guideline �I I%%date of this Ar n irieer� I g Receipt No. 0 Receipt No. Date of Payment — 0 �v Waiver Fee: $ — d Amount: $,/) Date of Payment 72-026 (Rev. 7/88) Back Page 2 of 2 fee • IFR C. REID, JR. . '. E - 2251 a Ar CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 IABORATO RIES FEDERAL TAX ID # 92-0040440 Client Sample ID:L3, B4 BEAR VALLEY PWSID :UA Collected NOV 18 88 @ 15:30 hrs. Received NOV 18 88 @ 16:50 his. Preserved with :4 DEG. C ANALYSIS REPORT BY SAMPLE for Work Order # 10558 Date Report Printed: NOV 28 88 @ 19:32 Client Name AECS Client Acct AR&CSRP P.O.# NONE REC'D Req # Ordered By Analysis Completed :NOV 21 88 Send Reports to: Laboratory Supero a r •STEPHEN C. EDE� i)AECS Released By G �GGjj``, 2) .................................................................................................................................... Special Instruct: Chemlab Ref #: 3499 Lab Smpl ID: 1 Parameter Tested ------------------------------------- NITRATE-N Sample ROUTINE SAMPLE Remarks: SAMPLE COLLECTED BY A. WIEN. Matrix: WATER Result/Units Method ------------------------------------------------- ND(0.10) mg/l EPA 353.2 Allowable Limits --------------- 10 .............................................................................................................. 1 Tests Performed ' See Special Instructions Above UA -Unavailable ND- None Detected See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than 0;�'0a3/2-2- MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH S HUMAN SERVICES , j Q�� DQ �S DIVISION OF ENVIRONMENTAL SERVICES (� CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 Application Date 3 ° 1. GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) C!- // // iv 012 z -7 V. �. Location (addressor directions) (b) Property, Owner ,�AK 64-0J' -L f Telephone: Home Business ;Ma+ling.Address Xo,� /o/�G� / (c) Leriding Institution, /���J���� �2 ' ' `I S 77IV- Telephone Mailing Address, (d) Real Estate Company and Agent r Address ?14 '<ze,do Telephone 1'2111-1211111 / .- (e) istcont Mail the Hhold for pick up. ct person and day phone number below. if 2. TYPE OF RESIDENCE Single -Family kf Number of Bedrooms 3. WATER SUPPLY Individual Well Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL OnsitqZ Public 0 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. 72-025 (Rev 8/86) Front Pagel of 2 4 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 S le— Telephone Address / 2 3 /it► � S'><e , c l �ti- � a 9� % 2 R'"� Date '?u i) ire;P '- 77Wk !A) SARiAJ(7 17S7, r.�►9► bhp ��Pt� VA) 7-36e-7- .a�F•A q �0 +..0 ..goes.. Sao*# . • �f•* ••••A•••• •. •• 6. DHHS APPROVAL y / Approved for %���,� bedrooms by Date _ 02 ic §19isappluv Conditional Terms of Conditional Approval 4i.2 2;5= CAUTION The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval certificates based only 'upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 . 72-025 (Rev 8/86) Back MUNICIPALITY119k*MEiY OF ANCHORAGE (MOA) ENVIRONMENTALW19AiWW(J1A40RITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 o 1988 264-4744 EE I V E p Legal Description: 3 V dz._ Y_ 1) ll A. WELL DATA Well Classification pri �� If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/� Date Completed Yield a G' e? /)j✓�£f Total Depth /s / Cased toyy" Depth of Grouting L)'k -z Static Water Level 3^ Pump Set At Casing Height Above Ground — Electrical Wiring in Conduit69/N) Separation Distances from Well: Sanitary Seal on Casing L'QN) Depression Around Wellhead (Y6I To Septic/Holding Tank on Lot ; On Adjoining Lots '> l�0 r To Nearest Edge of Absorption Field on Lot ; On Adjoining Lots > �� o To Nearest Public Sewer Line NIA To Nearest Public Sewer Cleanout/Manhole Ail 1-f To Nearest Sewer Service Line on Lot N%�9 Water Sample Collected by �' e ; Date Water Sample Test Results Comments k Sev" '4`I�t'-Tcc� ' S F l►G{� B. SEPTIC/HOLDING TANK DATA Date Installed aa�g y Size /000 No. of Compartments Z Standpipes/N) Air -tight Caps I1I) Foundation Cleanout/N) Depression over Tank (Y/9I Date Last Pumped Pumping/Maintenance Contract on File (Y/N) L-Im ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) IJ1119 Separation Distances from Septic/Holding Tank: To Water -Supply Well //o.,5'- To Building Foundation To Property'Line % To Disposal Field y� r To Water Main/Service Line _� - To Stream, Pond, Lake, or Major Drainage Cou:rs2 %y" Comments e&h/7%L)*- yr rJ77t- ly,,0iA)e / IN,i s-rhih %�,U� &,y1i*e 7? 69-7' ;a 577•' I)uL- t4 CoA/T105. Page 1 of 2 72-026 (Rev 8/86) Front C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Z C, Type of System Design Date Installed . V -1/6. y Length of Field �g Width of Field 0?. Depth of Field Gravel Bed Thickness c-3— -, 7 Square —S— Square Feet of Absorption Area & 3 Standpipes Present t9N) Depression over Field (Y/ IP Results of Last Adequacy Test A4y z Separation Distance from Absorption Field: To Water -Supply Well //6 Date of Last Adequacy Test �2�i6�S3 i To Property Line J-3 To Building Foundation /t%(4 To Existing or Abandoned System on Lot A) /A ; On Adjoining Lots > ZO r To Water Main/Service Line 5 z- f To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course >/00 r To Driveway, Parking Area, or Vehicle Storage Area > 20 Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments i Dimensions Manhole/Access (Y "Puma,W Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I hav � ck verifi , or conformed to all MOA and HAA guidelines in effect on the date of this inspection. `� �-- 3 _30 Signed Date Company �C`c S _Z.�� MOA No.OF At r�rr►�t►r,pR Receipt No. V3 L/"�9•0 •• • • H „� 4 Date of Payment Amount: $ /70-00 gi I•.... .. N.• wwwwww•ww•• wwwwr LEROY C. REID, V1 AF CE - 2251 Ar Page 2 of 2 72-026 (Rev 8/86) Back 0 '00 Conducted Owner Weil Location Well Information: WATLAWELL - TEST PUMP R[ JRT Tt1. Depth _ Casing Size Remarks — Screen From nen r" � .`Depth of Casing in i1 Screen Dlam n_ C(,y Screen Slot Pump Information: Intake Depth-Pump1 Size Static Water Level Pump On: Time --t—ryl Date L - Alr Line DOW DischargeOpM, Max. Drawdown ' r pump Off: TIE�ime - Dale c CHEMICAL & GEOLOGICAL LABORATORIES OF ALASKA, INC. " 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 FEDERAL TAX ID # 92-0040440 LABOFAtO PIES ANALYSIS REPORT BY SAMPLE for Work Order # 5249 Date Report Printed: FEB 22 88 @ 11:04 Client Sample ID:L3 B4 BEAR VALLEY Client Name AECS PWSID :UA Client Acct ARECSRP Collected FEB 17 88 @ 14:15 his. P.O.# NONE REC"D Received FEB 17 88 @ 16:26 hrs. Req # Preserved with :NONE Ordered By Analysis Completed :FEB 19 88 Send Reports to: Laboratory Supervisor :STEPHEN C..EDDEE / 1)AECS Released By : A*&— C. T. 2) .................................................................................................................................... Special Instruct: Chemlab Ref #: 9142 Lab Smpl ID: 1 Matrix: Water Allowable Parameter Tested Result/Units Method Limits --------------------------------------------------------------------------------------------------------------- NITRATE-N 1.8 mg/l EPA 353.2 10 Sample ROUTINE SAMPLE Remarks: COLLECTED BY A WIEN .............................................................................................................. 1 Tests Performed See Special Instructions Above UA -Unavailable ND- None Detected "' See Sample Remarks Above NA- Not Analyzed LT -Less Than, GT -Greater Than MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date OW -1w (a) Legal Description (include lot, block, subdivision, section, township, range) I-ot-3 00c KA jazu 2 r (1 A�s� T"lI N P :2_ty SL (2, 1 Location (address or directions) (b) Applicants Name'T. r4 U c, Telephone -_Home Business Applicants Address (c) Applicant is (check one) Lending Institution iex builder ; Buyer E::l ; Other F__:j (explain); _ (d) Lending Institution Telephone _ Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. TXpe of Residence Single -Family 5EI Multi -Family Number of Bedrooms 13 _ 3. Water Supply Individual Well m Community Other (describe) 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 FT Public [= Community [= Holding Tank = Note: If community well system, must have written confirmation from the State Department of Euvironmental Conservation attesting to the legality and status. G' [Page 1 of 2] t_3 tW &C� _Ii. 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 regula- tions in effect on the date of this inspection. Name of Firm " 6' t 'S� ',1&.ESTe1ephone,�4_/ /0 Address I, c)o a)c sl"_ 3, , S«fit Date (ENGINEER SEAL) 6. DHEP Approval Approved for %I/'rz )bedrooms Approved Disapproved Terms of Conditional Approval UI1 By -�-� �� (Lt��l<2- / Date Conditional CAUTION B{ a . 1 � •.� •ww ••�en.I1. �'0 N•� 1 oy C. Reid, Jr, THE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT— ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFf CERTAIN FEDERAL AND STATE REQUIRE— MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/ej/D18 [Page 2 of 2] 7-19-84 A. B. v� MUNICIPALITY OF ANCHORACI? DEPT. OF HEALT i ENVIRONMENTAL PICC i [ i .1CN MUNICIPALITY OF ANCHORAGE (MOA) NOV 1 X984 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 1 Legal Description: Lo'r 3N 4- WELL DATA A u6 , L LY -ra k) i22 J Sic. f� Well Classification P �,1�A, .14-� If B, or C, D.E.C. Approved(Y/N) N _ Well Pres nt (Y Date Completed Log $ Comp-iCv�e-urr� Yie S / 0 IF Total Depth h]S"f / Cased to -4/10 Depth of Grouting Static Water Level , 51 Pump Set At 1351 r) 3,) Casing Height Above Ground Sanitary Seal on Casing tV) Electrical Wiring in Conduit AN) Depression Around Wbllhead (Y . Separation Di tangs from Well: To Septic/ To Nearest To Nearest Water Sample: Water Sample Comments 0 Ing Tank on Lot i ) 0; t ; On Adjoining Lots 5/oc)r of Absorption Field on Lot j& ; On Adjoining Lots is Sewer Lire PL'/v4 To Nearest Public Sewer Ole A) To Nearest Sewer Service Line on Lot 61 1XII llected By _ . Date /11 P4/9!;L st Results .$',� �4� 3 12) i SEPTIC/HOLDING TANK DATA Date Installe 9/'4`f Size (p b o No. of Compartments Standpipes ) _Air -tight Caps N) Foundation Cleanout Y1) Depression oNmr Tank (Y Date Last Pumped V/A- Pumping/Maint nance Contract on File (Y/N) *'IA- ; for 4-)41 Holding Tank Nigh -Water Alarm (YM) w1A- Temporary Holding Tank Permit (Y/N) Separation Di tances from Septic/Holding Tank: To Water -Supply Wall / t p S To Building Foundation 4x5+ — To Property Line '741 0 To Disposal Field To Water Main Service Line A3(A To Stream, Pond, Lake, cr Major Drainage Course`� t � o� 2. Comments { Receipt # 30g 6 Q g Date Paid: Amount: 4 [Page 1 of 21 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 2Oo th Type of System Design rjeE4, ,,. Date Installed Vzz,/V-� Length of Field $[g' Width of Field ,�� Depth of Field /6,5� J Gravel Bed Thickness .S Square Feet of Absorption Area L37-0 Standpipes Present Depression over Field (Y&} Date of Last Adequacy Test�- Results of Last Adequacy 'lest A31 -A Separation Distance from Absorption Field: To Water -Supply VL -11X11 , To Property Line .3, 3 To Building Foundation fps To Existing or Abandoned System on Lot &) ,* ; On Adjoining Lots >�p 1, Z.) To Water Main/Service Line A,)(A- To Cutbank(if present) K)%. To Stream/Pond,/Lake/or Major Drainage Course—,,n.061 Z) To Driveway, Parking Area, cr Vehicle Storage Area 4tol Comments, d,,, i SQL`: - "_ �•� t SR.�►¢,� 'f1��l8( D. LIFT STATION Date Installed Size in Gallons "Pump Ori" Level at High Water Alarm Level at f r V F _ Di ns io s ! /P Odess (Y/N ) Off" Level at Vent (YM) Tested for `Pu Sing Cycles ing Adequacy Test. Meets MOA Electrical Codes(Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Gu on the date of this inscection. r----�'`, Signed Qx� OeO721- Date Company' MOA No. --02f KBl /d5/s [Page 2 of 2] 0 ines in effect �1 • • G e i S seCL.re . q• • •.o� :. Reid, Jr. 2251 Equ• •' oUcall 2-15-84 Conducted by J Owner J. Well Locatlon.lA Well Information: Pump Information: Pump On: Date: WATLAWELL - TEST PUMP Rk-.'ORT ^ �Dr�! f►nct .��-----+�V�. �nJ7� �YIC`hrr� -+ c Ttl. DepthDepthof Casing Screen From o Casing Size _Screen Diam 11C (I b Screen Slot Remarks Intake Depth Pumps Size Z Air Line Depth —{ Static Water Level v Discharge GPM, Max. Drawdown Time 2 •CC !!L rn Date ump Off: 4 ime Date " WN REMARKS I® � ®11"M MUM MOM0111 iii ��■■���. IIl � .• ®�►� NMI WN LAWRENCE A. SCHACHLEh s A - B - C PEEP & WELL SUPPLY 2833 EAST 72nd AVE. ANCHORAGE, ALASKA 99502 PEERLESS PUMPS MOTORS PIPE 8 FITTINGS Custome is COMPLETE INSTALLATIONS AND PUMP SEPVICE Order No. Date —),r .. 19. �_..- Name/'qGf o/E _ 1%10oE le'crull Address /f..i eI/e - t��9 9s -j LD BY CASH C.O.D. CHAgGEION ACCT. MDSE. RETD. PAID OUT QUAN. DESCRIPTION PRICE AMOUNT _ 3,c< ti (/ S747LI A,41 e .� 8 ,�x,1eWw Dor vAJ hoaf-e �r i TOTALSD ALL claims and returned goods DUST be occompanied by this bill 3898 Recd by MUI ICIPALI?Y OF ANCHORAGE DEPT. Of HEALTH & ENVIRONMENTAL PE:OTECTION s"N 2 2 ,981 RE CEIV 0