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T13N R3W SEC 22 LT 3
T13N R3W Section 22 Lot 3 #006-314-05 Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program. 4700 S. Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www cl.anchorage ak.us (907) 343.7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SVU 0;X O & PID Number. 4D0 1 L/— O Na^n _ to L Wastewater System: Cl New Upgrade Adaesa o L — go ,.e- ABSORPTION FIELD Prima MrmOw-er Beboorn, D,so Trmm p SMM. iranm 0 aw D Lbuna O Omar LEGAL DESCRIPTION Sb Rabna te.^– Twat DOOM from wageol grade P ,Fa q Fr B.O* La Subdawaan Down top broom frae aagnM grade Gruel dawh bernalh p'Fe L-0 S Ft it Tc sh-o Range 3w seam FA as ibove"p 91WO Cra. Lang+h t tT t 2— t Ft. / L 0 Ft. Wel(: ❑ New ❑ Upgrade Gr,vM WAh t Number or I",, t Dalarica OeMan Ines 5 FI. FI Cass 6ouen 1Prwale A S. 4Fk) TOY DOOM' Caged b TOY Wwrwan WO.P." Malarial � �`' FI. I FI - Flr 1? 10 O 3y D,,nr \:2Dole +FI polad Strwwatw La•M fttaw Data kaelanw tnl C OZ Y.e'd Pump sat+l Ca" H VN Above Ground TANK GPM FI. FL SEPARATION DISTANCES r�!L L95eplic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding PubbNP(vat MaNdact.er capac•ty From Tank Field Station Tank Sewer Line A c r 'OGal W.. ,1 N Material (' Slee Numbarw CahcHmams 101 10 /ar L SuOve Wa•.e• 14,10N�o N�� LIFT STATION a!a Manulxlwar lot L•ne '7c> J GM 'Pwip On NNr M 'Pump wf IWN el Hag" .01.1warm at FourNalen ?>5 in Cuna•n Oran V4 H) Paanp Make a ModM EwfnFAl ha came pedwMed by D Rama•ke BENCH MARK Lwalari ab Oaamwan e 'r1 S 67AaAcir r S a Puun•a0 Enna on �m��a burL o1611Ioc'=FI .-_'Enginger's Stamp S 9T Inspections performed by:10/ �S Oates: 1" G•W p4 . � nd Development Ser ices Department Approval Cz r j ' F4'°M - Reviewed and approved by-: l le/ 1C/ Date: •� IRo CM) -(�- well r .SIA — RDkACM 1250 CAI SOYC TAW ffim A 1FD R'A "WN UUN OUT II g ❑ - J IMI WTALLM SOW TRS SMAVARD 5 -WE WDKH AC 50 FT W FT LONG !k 3L6 5 FT NDf AD 72 I BD 72 0 AT Df2P I t FT SOMA ROCK D7F 49th00 I �? TUBBE SPURICLAND NO. CE-2223•••.�,� I . rr I 1 25 0 25 50 75 !A1 125 150 SCALE, P = 50 FT. Lar 14 I l0rdcn � 7H. AVNU r c. I I LOT 3 SEC. 22 T12N B3W I I S£PAC SYST£AI AS BU/CT I 203. AK. AVENUE 5206 f 20TH. AV£, DATE: OCT. 28, 2002 ANCH. AK 99501 DEAN FLEMAIING SHEET.• 213 GRID: 1537 .[907) 279-3916 PERMIT #SV020436 PID N 006-314-05 13322032.DV6 Standard Trench, 5' Vide 60' Long 8' Deep 4.0' Sewer rock 4' Cover HO SCALE S/t t 4.0 ft of Septic Rock Effective Monitor Cleanout - 4' Cover sst IVO SCALE u A1.0 90.0 1250 got Septic tank L .' 49th '. IiEN SPURKLAND No. CE -2225 •. NI "n 1250 got. septic tank I unnLn brUKKLAND r.L. LOT 3 SEC. 22 T12N R3Or SEPTIC SYSTEM SCHEMATIC Anchorage orage Ave11 5206 E 20TH. AVE DATE, OCT. 28, 2002 Anchornge Ak 99501 Day 111A SHEET, 3/3 GRID, 1537 PERAI/T I SWO20436 PARCEL ID f 006-314-05 13122033.DWO MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ONSITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Permit Number: SW020436 Legal Description: T13N R3W SEC 22 LT 3 /-qlZe0/b ' a Oing Date Issued: Oct 25, 2002 Expiration Date: Oct 25, 2003 Parcel ID: 006-314-05 Design Engineer: 0007 Tobben Spurkland, PE Site Address: 005206 20TH AVE E Owner Name: Dean Flemming Lot Size: 98228 SQ. FT. Owner Address: 5206 E 20th Ave Total Bedrooms: 4 Permit Bedrooms: 4 ANCHORAGE, AK 99523-0333 This permit is for the construction of: rVj Disposal Field ❑✓ Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ 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 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 closed on the same day. B. Covered, sealed, and heated to prevent freezing. Received By: Issued By: Date: I Z -q 1 0 Z Date: L% 2�— �z Municipality of Anchorage .� Development Services Department �^ ^ Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWERMELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. ODlo - 3Ir/-A 7 Permit Number SWL1204-36 Property cwner(s) D.ex Fit wt►tiri Day phone Mailing address (1) Mailing address (2 Zip Code Legal description (Lot, Block & Sub'd.) Leta: description (Section, Township & Range) Se C_ a 2r 1 13 !-I i�L 3 tel Lc: S:ze a �Y Acres4 , [• Number of Bedrooms "T THIS APPLICATION IS FOR: Sewer Only ❑ Well Only Sewer and Well ❑ Water Storage Sevier Upgrade THIS PROPERTY CONTAINS: Hot Tub ❑ Jacuzzi Swimming Pool ❑ Water Softening Unit Tnerapy Pool ❑ I certify tha! the above information is correct. I further certify that this application is being made fcr a Single Family Dwelling and is in accordance with applicable Municipal Codes. T7 (S:cna:;:re of property owner or authorized agent) Permit Fees. Waiver Fees: Date of Payment: t 0/22/" L Date of Payment: Receipt Number. lX I o' I `1 Receipt Number: (Rev tYCO) T.SPUR LAND P.E. 203 W 15th. Avenue, Suite 203 ANCHORAGE, ALASKA 99501 (907)279-3916 Fax (907)-276-6013 SEPTIC SYSTEM DESIGN LOT 3 SECT. 22, T12N, R3W 5206 E 2e. AVE. Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street Anchorage, Alaska 99519-6650 October 21, 2002 We are submitting an application for the upgrade of the septic system for this lot. The submittal consists of three (3) drawings showing the present improvements on the lot and the adjoining properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil logs and percolation tests of applicable testholes are also enclosed. The septic system design is based on the following: No Ground Water or Impervious Layer to 14 ft. Use Standard 5 -Wide Trench Soil Rating. From Testhole 10/18/02 1 min/in - 12 gal per sq.ft/day No. of Bedrooms 4 Required Area per Bedroom: 15011.2 = 125 sq.ft. Total area required: 125 x 4 - 500 sgft Testhole depth 14 feet Bottom Rock At 8 feet Top Rock At 4 feet Rock Depth 4 feet Reduction Factor .54 Minimum Trench Length 500 •0.54 / 5 s 54 ft. Use 60 ft SYSTEM CONFIGURATION STANDARD 5 -WIDE TRENCH TOTAL LENGTH 60 FT TOTAL WIDTH 5 FT TOTAL DEPTH 8 FT ROCK DEPTH 4 FT COVER 4 FT SEPTICTANK 1250 GAL The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent lots. There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots. The proposed septic system will not change the general slope of the area Ponding and/or concentration of surface runoff will not result from this installation. RUSSIAN JACK PARK E OTh AVENUE l p LOT 4 o- Vf''II � SI I I � o 1 ♦♦...,, to4 ' 49thio , ' P B saRKLum ; a J o. CE -2225 LOT 14 LOT 13 I I h Q S 50 0 w IPO ISP 2017 SCALE, 1' = 10i FT. �P E 22ND. AVENUE 0J W J7H. A EN E LUT 3 SEC 22 T12N R3W SEPTIC SYSTEM DESIGN ANC W 15TH. AVENUE 5106 E ?0TH AVE, DATE: OCT. 11, 2002 (NCH. 7 9916 DEAN ANT 1I1NG SHEET. 1 3 GRID: 1537 907 279-3916 � PERMIT #SV020XXX PID R 12322021DVG RE &CE 1250 61c � TAW , SOV rOU"nom LTEAN OUr I — ---1 Tx I RLSGLI. STAADW 5 -WW rRVKW 60 FT LaW 5 !T MqE Ll I Q FT DEEP I !T SEMFR Wff MON I ....�� 49ti 1 w C^ N 1 25 0 25 50 75 mu 125 150 SCALE! 1' = 50 FT. Lar 14 0 I 03 W J7H. AVru r c. LUT 3 SEC. 22 T12N R.3W SEPTIC SYSTEM DESIGN ANCH203. .TH AVENUE 5206 E 20TH. AVF, DATE. OCT. 21, 2002 (9077 77�976� ti— — .0 SHEET: 2/3 GRID. 1537 PERMIT #SV020XXX PID R 12322032.DVG ro--- -0-0. 0 0 0 1250 gal Septic tank o c a d Standard Trench, 0 y.. 5' Nide a 60' Long 8' Deep 4.0' Sewer rock 4' Cover OF t ;�r♦i �..».:....49th..»...».....»» :.»00 R TDBB N SPURKLAND •� ♦� ` No. CE-2225 'ti= ` '•� NO SCALE .• ♦♦1.;;�.•.,,••• Monitor Cleanout 4' Cover Silt Barrler 4.0 ft of Sept1c Rock Effective 1250 gal, septic tank HO SCALE TOBW15th Ave SPURKLAND P.E. 203 203 V1 LOT .� SEC. 22 T12N R3W F SEPTIC SYSTEM SCHEMATIC Anchorage Ak 99501 5106 E 20TH. AVE DATE, OCT 21, 2002 p7q-�tA Gnaw SHEET- 3 3 GRID- 1537 PERMIT SWO20OXX PARCEL ID / 006-314-05 13212033.DWC Municipality of Anchorage Development Services Department Boding Safety Division yr On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage. AK 99SIME50 www d anchcraceza .us (907) 343-7904 Soils Log - Percolation Date •- . 390 Township. Range. See .- MENEM "I ■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■■■■■ ■■■■■■■■■■ ■■■M■■■■■ mEMMIiiii Depth 02E7AWI L ,r,^ZL4I L•nSc- Ca ✓I%tt 1 16- S \/ COMMENTS WAS GF.CUND WATER ENCCL4ITERED? ^l G S IF YES. AT VhU1T DEPTH? L 0 Depth to Water After • p Ftonitoring? 011ti E Dale: i0"2 Reading I Date I Gross Time I Net Time - I Depth to Water I Nel Drcp FERCCLATIOFIP.ATE ��Ien:InYt�) FERC HCLE D-MST"cR TEST RUN 9EPNEEN Fi AND FT PERFOR`.IED BY: S I c'I S CERTIFY THAT THIS TEST VIA PERFORMED IN ACCORDANCE WITH ALL STATE AND MIRNCIPAL GUIDELINES IN EFFECT ON TrIS DATE. DATE: �G GRE1 `�R ANCHORAGE AREA BORT }IGH Department of Environmental Quality 11 3500 Tudor Road Anchorage, Alaska 99507 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM AI r✓ v Y' IP , c � Y� � NAMEC MAILING ADDRESS $�✓� CCZf/ `L '4W . PHONE LOCATION Cay^C'Uc�� C ��• �2 ' N 4/uLl1)CEGAL DESCRIPTION Z-OL3 -g)h �3W T13,/J S ,.Z -z, SEPTIC TANK: DISTANCE FROM WELL MANUFACTURER C77 {4C2�2°n INSIDE LENGTH INSIDE WIDTH NUMBER OF MATERIAL ✓ / COMPARTMENTS LIQUID DEPTH LIQUID CAPACITY GALLONS. SEEPAGE PIT: J '� NUMBER OF PITS / DIAMETER --OR WIDTH, LENGTH, DEPTH LINING MATERIAL � D CRIB SIZE: DIAMETER_EPTH 7 DISTANCE FROM: WELL. r �T TOTAL EFFECTIVE / BUILDING FOUNDATION Z0 NEAREST LOT LINE ABSORPTION AREA (WALL AREA) a �� SQ. FT. ADDITIONAL ABSORPTION 5 deI,'wpi 4/ 4 f ec Cc y!i r i✓ c � % vi V- ecfi �n WELL: TYPE dN ! / /'Q CONSTRUCTION BUILDING GJZ NEAREST NEAREST FOUNDATION LOT LINE SEWER LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED REMAR DISTANCES: DEPTH DISTANCE FROM: SEPTIC/oe,' SEEPAGE 7 Z Z� TANK SYSTEM / . DIAGRAM OF SYSTEM INSTALLED BY: U I r 1 �e��i C /cnih �1 !_ r PIPE MATERIAL: GC S� 1 ✓�h Z© - _ 7 5 ^ 400 O's, LOT SLOPE: II^iJYr REMARKS: S�i� WGS 9llL/c( 47 ` Al G4P<,yc� —G�.�r.=t✓ rvlayZor//1.1c� ..//-- v e cod cz „cl n ey 4 i t, DATE Cl �— 7 Z APPROVED- Form PW -026 M I certlfythe above true and torreFt. EIVE D Driller REC SEP 1 3 1993 FOSS DRILLING 1336 INGRA PH. 279-2849 'A Municipality of Anchor SP#OIIAGE, ALASKA 99501 Dept. Health & Human We advise you to. attach this certificate to your deed. 7 se j Certified Well . . . . . . . . . . Description of Formation W to Bur .......... ...... i .... ............................. o r., F r Rlahard L.# r. t 0 ... .... ----- ............ ...... . ClayjSa d&G 9vf--I MU6'.Aed.: Location ...... ...Lot. .... Ba .... Tvkok-.�U ...................... ........ .... . ................. 82 a Date Complete .... .. ...... .......... .......... Depth of well .14a ... FtPt ... ...... ------ ............... .............. ..... .......... Sizeof casing U&.. Inch ....... ............. ................. ......................... ............... F—Ine.--aa—nd--Wttb. ---- Distance to water -- ---------- ..................... a7� Olay & Grate! ... ............................ �� Distance to waterwhile pumping Feet ...... ........... �at rate nth r� of ----- --------- ........... --- gallons per hour - 136 140 I certlfythe above true and torreFt. EIVE D Driller REC SEP 1 3 1993 FOSS DRILLING 1336 INGRA PH. 279-2849 'A Municipality of Anchor SP#OIIAGE, ALASKA 99501 Dept. Health & Human We advise you to. attach this certificate to your deed. 7 se j Description of Formation from to Sand & t 0 50 ClayjSa d&G 9vf--I MU6'.Aed.: 50 82 a Clay ElIuA-�-d 10 F—Ine.--aa—nd--Wttb. 10 5. 115 Olay & Grate! .115 136 sand & rra7—Pi—wLtLjftt6j—,. 136 140 I certlfythe above true and torreFt. EIVE D Driller REC SEP 1 3 1993 FOSS DRILLING 1336 INGRA PH. 279-2849 'A Municipality of Anchor SP#OIIAGE, ALASKA 99501 Dept. Health & Human We advise you to. attach this certificate to your deed. 7 se j GREATER ANCHORAGE AREA BOROUGH i DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. • jd! 3500 TUDOR ROAD POUCH 6650 ANCHORAGE, ALASKA 99502 TELEPHONE 279.8686 SEWAGE DISPOSAL SYSTEM ® APPLICATION AND PERMIT NAME OF APPLICANT /���/7✓�//H� MAILING A/DDR ESS INSTALLATION LOCATIONcam✓ ���jr LEGAL DESCRIPTION / J D ///' LAGS%- /G �✓/ 4"� INSTALLATION OF: SEPTIC TANKy SEEPAGE PIT DRAIN FIELD OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH GI TO BE INSTALLED BY SOIL TEST RESULTS 7 NOTE: THIS PERMIT 1S NOT VALID WITHOUT SOIL TEST COMPLETION DATE ANTICIPATED / 2— FINAL FINAL INSPECTION, 24 HOUR NOTICE REQUIRED. BACIWILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH DEPARTMENT AUTHORITY WILL BE SUBJECT TO giOSECUTION. SEPTIC TANK SIZE TYPE S /CSA-' e; -ex MINIMUM DISTANCES, REQUIREMENT'S ! 1� FOUNDATION TO SEPTIC TANK --. FOUNDATION TO SEEPAGE PIT �Q DRAIN FIELD /! TIC TANK TO SEE /PAGE PIT WALL � C� / 70/ SEPTIC TANK "� SEEPAGE PIT. DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK > ,SEEPAGE PIT DRAIN FIELD ALSO CONSIDER AREA WELLS. ! ! WATER MAIN TO SEPTIC TANK �� SEEPAGE PIT �G , DRAIN FIELD SEPTIC TANK, _'LS SEEPAGE PIT DRAIN FIELD , TO RIVER. LAKE. STREAM. CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. WEALTH AUT OITY --�^— OR LICENSED DESIGNER 1 CERTIFY THAT 1 AM FAMILIAR WITH THE REQUIREMENTS OF GREA' DESCRIBED SYSTE/M//IS IN ACCORDANCE WITH SAID CODE. DATE ;';j/ APPLICANT'S SIGNATURE AREA SIZE TYPE t DIAGRAM OF SYSTEM ANCHORAGE AREA BOROUGH ORDINANCE NO. 28.68 AND THAT THE ABOVE TS "IS -111 - Municipality (f,-11z Municipality of Anchorage �0 • —+ Development Services Department ar. Building Safety Division ' On -Site Water and Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519.6650 www.ci.anchorage.ak.us (907)343-7904 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAl1lIILY DWELLINGl>AS t t , Parcel I.D. OOIo - 3i'r<- 05 HPA i' 'b2D Sur% Expiration Date:. 7 - L� - 0 J 1. GENERAL INFORMATION Complete legal description LoT3 5t=G Q2'; 71 141 Location (site address or directions) 51vb E lou+ A.�z Current Property owner(s) Pe& -u1 Fho"rw%NY, Day phone. 3 3'3- Q yet Mailing address A-k� Lending agency _ Day phcr.e Mailing address Real Estate Agent C L jA Day phone ' Mailing Address Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY:' TYPE OF WASTEWATER DISPOSAL: Individual Well C� 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 sample results. (Certificates may be reissued for a pericd of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Health Authority Approval Guidelines for this application, shows that the on- site water supply and/or wastewater disposal system is(are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm i e)bke v 7pyv- VCaw d Phone AV-S41t, Address 20-z' ?J7_v-; Engineer's Printed Name 5. DSD SIGNATURE Approved for --I+ bedrooms. Disapproved. Date t o/Zkle z Conditional approval for bedrooms, with the following stipulations: Additional Comments Y OF WATER AN m Attachments: HAA Checklist X Septic System Advisory Well Flow Advisory Maintenance Agreements Supplemental Engineer's Report Other By: / �/ / - + 2�� Original Certificate Date: j - 44 - 0 � (Rw. 01102) Municipality of Anchorage Development Services Department , Building Safety Division ` On -Site Water & Wastewater Program 4700 South Bragaw SL P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: 1-.O i S See, 20 T1 -6W. ;; V1 Parcel ID: OCG— 314-05 A. WELL DATA Well type Date completed q'��7: Total depth ( 0 ft. If A, 8, or C provide PWSID # N/'r Sanitary seal (Y/N) Cased to 14 0 It FROM WELL LOG Date of test Jq17 L Static water level u ft Well production 3 g.p.m: • .Well Log (Y/N) *-% Wires properly protected (Y/N) Casing height (above ground) 12+ in. AT INSPECTION -61 ft. WATER SAMPLE RESULTS: Coliform colonies/100 ml. Nitrate N D mg.A. Arsenic: mg.A. Date of sample: �j-� Y - B. SEPTIC/HOLDING TANK DATA Tank Type/Material Tank size ) 2 5 y gal. Number of Compartments Other bacteria Nti colonies/100pmi. Collected by: i . S➢uik IaN cC Date installed 1026% Z Cleanouts(Y/N) Foundation cleanout (YIN) Depression over tank (Y/N) t High water alarm (Y/N) ti 1 Date of pumping ✓ Pumper C. ABSORPTION FIELD DATA Date installed ' 110./Z� o Soil rating (g.p.d./ft2 or arm) �� - System type Length LD fL Width J ft. Gravel below pipe _� ft. Total depth Cl ft Eff. absorption area Monitoring tube Depression over field N Date of adequacy test H/A Results (Pass/Fail) ✓ For t-/ bedrooms Fluid depth in absorption field before test _✓in. `' Water added --- gal. 'New depth�in. Elapsed Time: t/ min. Final fluid depth ✓ in. Any rejuvenation treatment (past 12 mo.) (Y/N & type) Absorption rate >_ ✓ g.p.d. If yes, give date J D. LIFT STATION Date installed 'Pump on' lev7atin. Datum E. SEPARATION DISTANCES Size in gallons ;2ateralarrn ' ccess (Y/N) 'Pump off level at _ in. level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot 10 On adjacent lots > /o O Absorption field on lot t 0 3 On adjacent lots 7 /0-n Public sewer main 4-4l/.4 Public sewer manhole/cleanout N/A - Sewer /septic service line > Holding tank NA SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation S5 Property line 70 Absorption field P- Water main N/A Water service line LO Surface water tq %o Weiss on adjacent lots 100 "t SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: 1 Property line #i `J^ Building foundation q 5 Water main H 1 O Water Service line 60 Surface water N 1 O . Driveway, parking/vehicle storage b0 Curtain drain t-41 O Wells on adjacent lots i APV F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA HAA guidelines in effect on this date. Engineer's Printed Name I a b %r vl Soy r In K t� Date 0(-4 HAA Fee $_ 37,5'0 0 Date of Payment _ to 17AIC -I- Receipt Receipt Number 1 5 O (Rev. 12/01) Waiver Fee S Date of Payment Receipt Number in. A.. C_Ti_E_Environmental S_arvleac Inc. I YI I Y IY Pt- _..5:: . CT&E Ref.# 102714300. All Dateslllmes are Aloka Standard Time Client Name Tobben Spurkland P.E. Printed DatelTime 10!27!2002 7:37 Project Name # U. Set 22 T12N R3W Collected DateMme 101912002 10:15 Client Samp!e ID L3, Sec 22 Received Da�titeelTiiimfe 11:00 i11aMx Drinking Water "12002 tephen C, Ede Teebnica��-4/ PWSID 0 Rdw B [n,{�/C7L � Sample Rertnrkc Allo"'.4a Prep Analysis Pumw,a Res.dts PQL Units MCOrod Limits Dela Dete snit Natora Departewnt Nitnte-N 0.2000 0.200 mr— EPA 3000 (<=10) 10/13/02 JS Microbiology Laboratory Total Cohform 0 coVIOOmL SM1892226 (<-1) 10/10'02 BAG i 10/51/02 TRU 14:55 FAX 907 582 5485 PRUDE\TIAL VISTA REAL E x,'001 I o .0 ,IF,t 1Lr �{e /R SfY I; F.:• e SF d. 7 .•r los BAST Zor" AYE we • ' A 6 �p� J i C- -— L[wc- fyfGO ' - pa:,'cna:r reNcr Lor 3 C If :�harn lint ;enCt EASEMENTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT, ARE NOT SHOWN HEREON. 9" F--M-I G r THE INFORMATION HEREON IS FOR TME LSE OF LEN0140 INSTITUTIONS SPECIFICALLY TO SHOW ANY CONFLICTS SETWEEU EXISTING STRUCTURES AND PLATTED LOT LINES OR EASEMENTS AND IS NOT TO BE USED FOR POSITIONING AOOIT,ONAL STRUCTURES OR FENCEUNES. "ASBUILT" No comors Bet Boek C9 PrcF I3LM 1 hereby cel ty that I rave surveyse Ne toeowing deaalMd properly. Lot _S SICCA /N If EJ4 4Anchorage recording dlstnCt A1808. Ord that the krprov$ +ents eduated lhere0n a's wenn Ine prCpe'ty Ones end do not over sp or OnCtOACh on the prcparty lying adjacaM thereto that no Irtprovemares on property lvirg adleasM tMnto encroach *It" premises it d ueetlon and that there are no roadways. transrn'sslon Ilnes or other wabte eal"onts on as d prop+rtY WOO n lndlutsd Mason. Mchoragv. Alaska 27 CC f• 20 ZP A 4 I s'•. No. 13083 f ' .• k`i ortsS o:ph.�*:+r z MUNICIPALITY OF ANCHORAGE • '� DEPARTMENT OF HEALTH & HUMAN SERVICESi i 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 _Irl Parcel I.D. # C)DI n - 2Vi - (lh 1. GENERAL INFORMATION HAA# l�ilGl�i(n��ri Complete legal description T13 N 8311 Section 22 Lot 3 Location (site address or directions) 5206 E 20th Ave; Anchorape Property owner Mr: y Elaine Hanni Day phone 338-3860 Mailing address- 5206E 20th Ave Anchorage Lending agency Seattle Mortgape Co. Day phone 562-5626 Mailing address 560E 34t -h Ave. Suite 100 Anchorage Agent Lenny Collop Day phone 562-5626 Address 560 E. 34th Ave. Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3. TYPE OF WATER SUPPLY: Individual well Community well Public water 4 V 6-2,4 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 MOA#21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application 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. :t. Name of Firm Address 907 E. Engineer's signature 6. DHHS SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for Additional Comments 0 Phone(907)562-2580 Date /3 E OF John Earl Simpson CE -8061 �ROFESS10tts', bedrooms, with the following stipulations: Date r /-93 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 courtesyto 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. ]242S(RW.V91) Back MOA#21 Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: Tl NR3W Section 22 Lot 3 Parcel I.D. a b & " 3 / 5Z- 0 A. Well Data Well type Private If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Y Date completed 9-4-72 Driller Foss Drilling Total depth 140 Ft. Sanitary seal (Y/N) Y Date of test Static water level Well flow Pump levell Cased to Greater than 40_�Ft. Casing height 1 ft. 3 in. above G.L. FROM WELL LOG 9-4-72 30 not mentioned SEPARATION DISTANCES FROM WELL TO: Wires properly protected (Y/N) AT INSPECTION 8-26-93 37 ft. g.p.m. 5 Unknown Septic/holding tank on lot 106 Ft. ; On adjacent lots 100+ ft Absorption field on lot 123 ft. On adjacent lots 100+f t. Public sewer main N/A Public sewer manhole/cleanout Sewer service line N/A Petroleum tank N/A WATER SAMPLE RESULTS: Coliform 0 Coliform/100M1 Nitrate 0.10mg/L Other bacteria Date of sample: 8/26/93 Collected by: B. SEPTIC/HOLDING TANK DATA Date installed 9/1/74 Tank size 1250 Gallons Cleanouts (Y/N)•." Y Foundation cleanout (Y/N) _ High water alarm (Y/N) N Alar Date of:pumping 5/10/93 Pum SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Compartments Depression (Y/N) tested (Y/N) Denali Sewer & Drain Service Well(s) on lot 106 Ft. On adjacent lots 100+ Ft. Foundation 20 Ft To property line 20+ Ft. Absorption field 23 Ft - Water main/service line N/A Surface water/drainage 100+ Ft. 72-026 (3/93)' Front CONTINUED ON BACK PAGE C. LIFT STATION N/A Date installed Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Manufacturer Manhole/Access (Y/N) "Pump off" Level at tested Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed 9/1/72 Soil rating (GPD/Ft2) Unknown System type Crib Length 24 ft. Width 18 ft. Gravel thickness 7 Total depth 11' Total absorption area Untmown a0"Ceanout present (Y/N) Y Depression over field (Y/N) N Date of adequacy test 8/26/93 Results (pass/fail) Pass for 4 Bedrooms Water level in absorption field before test 5 ft. frorn bottom After test 5 ft. from bottom Peroxide treatment (past 12 months) (Y/N) yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot 123 ft. On adjacent lots 100+ ft. Property line 100+ ft. To building foundation 61 ft. To existing or abandoned system on lot On adjacent lots 100+ ft. Cutbank N/A Water main/service line Surface water 100+ ft. Driveway, parking/vehicle storage area 60 ft Curtain drain N/A E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or Signature to all MOA and HAA guidelines in ms's Name \ (')n -r J -2-S HAA Fee $ _3 -62o - Date of Payment C/ /3-`i3 Receipt Number 3¢ U 72-026 (3/93)' Back Waiver Fee $ Date of Payment Receipt Number CE -8061 P6F"ESS10t�` this inspection. COMMERCIAL TESTING & ENGINEERING CO. ENVIRONMENTAL LABORATORY SERVICES E 1908 REPORT of ANALYSIS 5633 B STREET Chemlab Ref .# :93.9371-1 ANCHORAGE, AK 99518 Client Sample ID :5206 E. 20TH, T13N RW SECTION 22 L3 TEL: (907) 562-2343 Matrix ,WATER FAX: (907) 561-5301 Client Name :ENVIRONMENTAL MGMT INC (EMI) WORK Order :70114 Ordered By :D. NEDGI Report Completed :08/30/93 Project Name Collected :08/26/93 @ 13:05 hrs. Project* Received :08/26/93 @ 16:05 hrs. PWSID :UA Technical Director:STMiEp C. ME Released By s Sample Remarks: ROUTINE SAMPLE COLLECTEDBY: D. NEOGI. QC Allowable Ext. Anal Parameter Results Qual Units Method Limits Date Date Init -----------------------------------------------------------------=--------- - - ---------------- Nitrate -N 0.10 U mg/L EPA 353.2/300.0 10 08/27 LLH ----------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- * See Special Instructions Above UA = Unavailable ** See Sample Remarks Above NA = Not Analyzed U = Undetected, Reported value is the practical quantification limit. LT = Less Than D = Secondary dilution. GT = Greater Than r®SGS' v Member of the SGS Group (SociBt(5 GE!nArale de Surveillance) ENVIRONMENTAL SERVICES IN ALASKA, COLORADO, UTAH, ILLINOIS, OHIO, MARYLAND, WEST VIRGINIA, NEW JERSEY, SOUTH CAROLINA - .011 MWICIPALIPY OF ANCHORAG� ' DEPARTML i OF HEALTH AND ENVIRONMEN L PROTECTION 825 L Street, Anchoraaa, Alaska 99501 264-4720 Date Received: February 1, 1978 #1: TimeV #2: Time a'�� #3: Time DateM044 l �Date a-��- l� L�FsJ Date 4:Insp — Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: % Claudia Jones Alaska National Bank of the North Mailing Address: Pouch 7-010 99510 Phone: 278-4581 2. Property Owner: Richard Burr Phone: quu� Mailing Address: % Blaine R./Darlene Hn=i, 333-8890/h 272-5522/254 �3Pt �23w S£c az S-€� zA7 3 3. Legal Description: rd 5 A Single Family Residence: (yj Multiple Family Residence: ( ) Number of Bedrooms: Four Number of Bedrooms: Well System: Individual Well kyj Community/Public System ( ) Permit # Construction Depth of Well Well Log on File ( ) Bacterial Analysis Sewage Disposal System: On-site System (x) Permit # Septic Tank Size Absorption Area Installed Public Utility ( ) Installer Manufacturer Soils Rate 7. Distances: Well to Septic Tank to Sewer Line to Nearest Lot Line Nearest Lot line Material to Absorption Area Absorption Area ?"ex 'Y/' i MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L Street, Anchorage, Alaska 995o� 279-2511, ext. 224, 225 - f REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: 2. Property Owner:_ 1/30/78 VA FHA CONV XX Mailing Address: Utah Day Phone: n/a 3. Name of Buyer: Blaine R. & Darlene Hanni Home: 333-8890 Mailing Address: 5206 E. 20th Ave. Anchorage, AkDay Phone: Wk:272-5522 X254 4. Name of Lending Institution: Alaska National Bank Mailing Address: -Pouch 7-010 Anchorage, Ak. Phone: 907-278-4581 99510 5. Name of Realtor or Agent: n/a Mailing Address: n/a Phone: n/a 6. Leg�l Description: Govt. Lot 3 according to the official plat of the survey of said land, Ei e with the Bureau of Land Management, situated in Sec. 22 T13N R3W Seward Meridian. Location: 5206 E. 20th Ave. Anchorage, Alaska 99504 7. Type of Facility to be Inspected: Singel-family Dwelling No. Bdrms 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served 1 If Individual, depth of well 9. Sewage Disposal System Type of System Public Utility If Individual, date of installation 4 W Individual (on-site) XX Call Buyer for appoinment; he is occupying the property at this time. Seller is out-of-state. Thank � you, Claudia kJo Senior Loan Processor Alaska National Bank 72-003(3/76) Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: T13N R3W Section 22 Lot 3 Comments; Affadavit Attached: ( Approved: Disapproved: Department Worksheet: Letter Attached: ( ) Date: a Date: AL John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279.8056 February 27, 1978 Blaine Hanni 5206 East 20th Ave. Anchorage, Alaska Subject: Tests on Existing Drainfield for the Four Bedroom House on L. 39 S.E. 1/4, Sec. 22, T. 13 N., R. 3 W., S.M. Dear Mr. Hanni, At your request, the writer performed the tests reported on the attached sheets in an effort to evaluate the adequacy of the drainfield in use on the referenced property. Discussion with Mr. Bob Pratt of the Municipality of Anchorage Department of Environmental Quality indicates that there is no record of the type or size of the existing system. Discussion with Mr. Blaine Hanni on February 23, 1978, indicates that a drain field accepts the effluent from a 1500 gallon septic tank. Mr. Hanni reports that the system backed up in late January 1978. He reports that the septic tank was pumped and the line connecting the tank with the house was cleaned with a "snake's at that time. He reports no other problems with the system since that time. The liquid level in the septic tank was measured at 6'-3 3/4" below the top of the vent pipe at 11:00 a.m. on February 24, 1978, then 700 gallons of water was pumped into the tank at approximately 12 gpm. The liquid level was monitored at 50 gallon intervals with the results presented on Sheet One, attached. On February 25, 1978, the liquid level was measured at 6'-3 3/4" at 2:30 p.m. An additional 700 gallons was then entered into the tank with the results shown on Sheet 2. The system was reported to be in normal use prior and during the two tests. Within 10 minutes after cessation of pumping on Feb. 25, 1978, the liquid level .returned to within 1/4" of the original level ( measured at the beginning of each test.) At no time during the tests did the liquid level rise more than 211 above the original level, nor was there reported to be any water backing up into the house. The design effluent load for a 4 bedroom house is 600 gpd. In each test, we pumped the equivalent of a normal days use into the tank. The system was in use at the time of the tests, supplying additional effluent. The system appeared to adequately accept this hydraulic loading. Very Truly Yours, John M. Lambe, P.E. Civil Engineer 4254-E attachments JML John M. Lambe, P.E. 4303 North Star Street Anchorage, Alaska, 99503 907-279-8056 EXISTING DRAIN FIELD TEST - PERCOLATION ADEQUACY REFERENCE:%500 � �evAe, VW,,,7- DATE �-94� P FORMED BYs_t/o�x, LEGAL DESCRIPTION: 4oT 3 SE / e JML SHEET �OF 7? John M. Lambe, P.E. 4303 North Star Street Anchorape, Alaska, 99503 907.279.8056 EXISTING DRAIN FIELD TEST - PERCOLATION ADEQUACY REFERENCE:_TdT�- eyC �ff��sL�i.,rs4t TNT' DATE/ZG�� PERFOlMED BY:� ia41 r.1-�M(3C LEGAL DESCRIPTION: L3 S E VW0Ste. 1 'l3 DEPTH BELOWI METER READING I GALLONS PUMPED I TIME I PvvVpvKrF. f aAT.TAV.q 1 f mem 1 16%�- 3374 v o 4a /4 o SCS z' G�- Z 14. 17 7e-,). D too 2!ZA Z3-)1140 iSd 2' 4 7 Z40 z :Sa 3 U Z: 33 STw 3 ; 1 3 75�.o S ell ' -Z 37 d d 31 l Z/4 '• 3 7G4 G t O Z, Z Cof - Z/4- D 700 3'. Z 3'3 -3 -?e, 961> :37 MUNICIPALITY OF ANCHORAGE DEPARTME( HEALTH AND ENVIRONMEN, PROTECTION ') 825 L Street, Anchorage, Alasxa 99501 U05,1")0. 279-2511, ext. 224 or 225 7-V 77 t cutt mQr�P Date Received: July 6, 1977 /)&ut3u4_ R #1: Time #2: Time #3: Time 1 Date Date Date Insp Insp Insp REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES Lending Institution Request: Alaska National Bank of the North Mailing Address: Pouch 7-010 99510 Phone: 278-4581 2. Property Owner: Mailing Address: 3. Legal Description: Richard L. Burr % Blaine R. Hann 333-8890 T13N R3W Section 22 SV, Lot 3 4: Single Family Residence: ( $ Multiple Family Residence: ( ) Phone: Number of Bedrooms: Number of Bedrooms: two 5. Well System: Individual Well (x) Community/Public System ( ) Permit # Construction Jay Depth of Well Well Log on File ( ) Bacterial Analysis _ 6. Sewage Disposal System: On-site System (x$ Public Utility ( ) Permit # Installed iq'a Installer Septic Tank Size )A,60 �aZ j nj _ Manufacturer [ Absorption Area Soils Rate Material 7. Distances: Wel]. to Septic Tank to Sewer Line to Nearest Lot Line Nearest Lot line to Absorption Area Absorption Area MUNICIPALITY OF ANCHORAGE n y e DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION ,, ;..Ir,�I - 5 TI (•( 825 L Street, Anchorage, Alaska 99501 279-2511, ext. 224, 225 JJLI REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES 1. Type of Inspection: VA FHA CONV 2. Property Owner: Z/et<q�A G GIRR Mailing AddrQss: Day Phone: A-90 75-6 - 9.23z /, M e R. , c Hn/ FO /c 07/4/�� Sy00 Z 3. Name of Buyer: 1S! .q/ivE js -IY,OA/ov / Mailing Address:z�1/2 KENKA 4. Day Phone: 4. Name of Lending Institution:,, ,*t 9/e A iL�t �ion� �'Au/� e)F' 77V£ ,riO�TiY n Mailing Address: c W %-O//O Phone: 2 7&-' YS8 / i o 5. Name of Realtor or Agent: Mailing Address: Phone: 6. Legal Description: 1-74J 5F > SEt .?;QT /3,ov, Location: RIdSS/ 9N \,/,#� /c 7 0 Type of Facility to be Inspected: �M p , No. Bdrms. 2 Water Supply Type of Supply: Public Util If Individual, number of dwellings presently served If Individual, depth of well Sewage Disposal System 72-003(3/76) Individual Type of System: Public Utility Individual (on-site)' If Individual, date of installationK.t9F�c9A� E 5 Page Two Department of Health and Environmental Protection Request for. Approval of Individual Sewer_ and Water Facilities Legal. Description: T13N R3W Section 22 SE; Lot 3 _ Comments: Affadavit Attached: ( } Letter Attached: ( ) Approved: .— .� T Date: --- — — — Disapproved: —�—�_ Date: Department Worksheet: