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HomeMy WebLinkAboutNEWBY LT 1 "r te MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://wv vw.muni.orglonsite Ott -Site Wastewater Disposal System Permit Permit Number: OSP191275 Work Type: SepticTank Upgrade Tax Code Number: 01508127000 Site Legal Address: NEWBY LT 1 6:2439 Site Mailing Address: 9620 GROVER DR, Anchorage Owner: DE STEFANO PETER & Design Engineer: PANNONE ENGINEERING SERVICES This permit is for the construction of: ❑ Disposal Field O Septic Tank ❑ Holding Tank ❑ Privy Effective Date Expiration Date D partrneut 7/24/2019 7/23/2020 Lot Size in Sq Ft: 90300 Total Bedrooms: ,4 6 ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Special Provisions: The Diverter Valve is to be replaced with a Flow Splitter. Received BN Issued By: Co >M) LnCX'eayej beJfooPn cmN,rt f- -t-c, 6. q/,611y /I Date: 7 // Date: MUNICIPALITY OF ANCHORAGE Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On -Site Water & Wastewater Program ON-SITE SEWERWELL PERMIT APPLICATION Parcel I.D. 015-081-27 Property owner(s) DE Peter & Margaret Stefano Mailing address 9620 Grover Drive Anchorage, AK 99507 Site address Same Legal description (Sub'd., Block & Lot) Newby Lot 1 Day phone Legal description (Township, Range & Section) Lot Size 90,300 Sq. Ft. Number of Bedrooms 5 APPLICATION IS FOR: (ED all that apply) Absorption Field ❑ Septic Tank Q Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ APPLICATION IS AN: Initial ❑ Upgrade 0 Renewal ❑ TYPE OF DWELLING: Single Family (SF) Q (w/wo ADU) Duplex (D) ❑ Multiple Dwellings ❑ (SF and/or D) THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or agent) Permit/Rush Fees: `9o? 5- DID Waiver Fees: Date of Payment: 02 oC'011 Date of Payment: Receipt Number: 03 (0 V (-1 Receipt Number: Permit No. ©S PI q 135 Waiver No. Permit App_-'- :• .'-..:c: CZ Do Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveC@panengak.com August 5, 2019 Subject: Newby Lot 1 Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade Septic Tank to replace an existing 1,250 -gallon Septic Tank to be issued for this property. The existing tank is in failure and undersized, it will be removed per code. Currently the lot is developed. The proposed system will utilize a replacement Infiltrator IM - /250 G -15:3#6ingle compartment Septic Tank and IM -1060 single compartment Septic Tank that will be connected Kgo the existing drain fields. This lot and the surrounding lots are served by private wells. There are no wells within 100' of this upgrade. 1. Upgrade Tank Design. A foundation clean out installed if needed. The tank will be located: 5'+ from any property line 10'+ from building foundation 10'+ from any water line 100'+ from any surface water 100'+ from any private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.745.8200. Sin el Steven R. Pannone, P.E. Owner/Civil Engineer 0 -� '-t C7 ,-• ^ -i C cn D �7 D (/� 'U ^ -1 Z 7J -' C v Z -D �n-,v,00--m I I O�Icn -<Om;O-10-13 Zrrl70 ONS DO -0 -Do m Io rn zin �0m� �° Z • cn 0U,m Z: - m Dt- r DCD n�� DO m oo.. �Q1 > %n -n Cpm -t7 -+� Dx z "� m_-�D AX N o < U7(n Nu � G7 v0p00mx A C I ;U Ln Gym DOOp={ ( N A m N� c z> o- - I �•''io -I.. z.. 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OS ZZ O x Z =2Di �� -%i m0 Oma r �O m C m >9: N 0 m W 0 2 T� = 2 D 0 U1 O Z C) r D 0 v D 0 T7 > z D >- Z _1 z 0 U) m� a m M iA N Dz n D 0* <:; = O oo z Ln OC) Em m F� A m -• omb SoaP O Z N O 10 N N z� N p A o L1 I on p 0 D ON m p D m m 0 O m m z y D r r m v 2 NOTES: PANNONE ENG SVC, LLC REVISIONS DATE FOR CONSTRUCTION P.O. BOX 102954 ANCHORAGE, AK 99510�OFAlgkil 7/1/2019 PHONE 907 272-8218 FAX 907) 272-8211 i�P� ' •5' ll REV 1: 7/11/19 SCALE REV 2: 8/5/19 NEWBY L1 • ..y P.I.D. NO DRAWN ACP DE PETER & MARGARET STEFANO .• •••n orqe 015-081-27 CE SOILS LOG & ANCHORAG9620 E, D99507 VE +Zill�•��sso9��/ sH�ETPts1275 NOTES i\\\\���— 2 of 2 LIM T------------------ 10' -- ----- I I I I I I I f � % I SH A.C. `' 04 I °Nfir c. W pCK eft L Is I r % 11VO w '9UlLDING 50.0' o t=- SEPTIC SYSTEM N =I 9 x O o O °I ® I X e z I x� 62.1' I I I I I I i I i S 89052'57"E 250.56' 1 "it' t r t reti / ,4/ N O 42 r\ O_ M 00 Co ci 0 a z PLAT * 81-199 NEWBY SUBDIVISION LOT 1 90,300 N 89057'18"W 629,71' N 89057'18"W 380.00' BUILDING DETAIL SCALE: 1 "=20' AS -BU i L GASTALDI LAND SURVEYING, LLC JEFF A. GASTALDI, R.L.S. 2000 E. DOWUNG RD., SUITE 8 ANCHORAGE, ALASKA 99507 PHONE 2455454 GRID I DATE ISW2439 112/10/2015 F.B. I JOB NO. 07-12 1 NSLOT, Z,o I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO _ DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. I "I-.'CHORAG E RECORDiRG DISTRICT, ALASKA NOTE: NO CORNERS SET THIS DATE OF 49THjo . Jeffery A. �i.- VcO Air 10, LS -60911 { mAV f "essionaX i ��=50 W �} ao i --------------------� 30'I� - NQ W TO 0 0 NOTE: A.C. DRIVEWAY ENCROACHES ONTO LDT 2. I I HEREBY CERTIFY THAT I HAVE SURVEYED THE PROPERTY DEPICTED ABOVE AND THAT NO ENCROACHMENTS EXIST EXCEPT AS INDICATED. IT IS THE RESPONSIBILITY OF THE OWNER TO _ DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT. UNDER NO CIRCUMSTANCES SHOULD ANY DATA HEREON BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES. I "I-.'CHORAG E RECORDiRG DISTRICT, ALASKA NOTE: NO CORNERS SET THIS DATE OF 49THjo . Jeffery A. �i.- VcO Air 10, LS -60911 { mAV f "essionaX i ��=50 Municipality of Anchorage Page DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: ~(~o 16% PID Number: ol~' - ~,~ -'z'~ N~: Ce~ +... ~~ 0~,~ Wastewater System: E] New ~ Upgrade Address: ABSORPTION FIELD No. of B~rooms: Phone: ~.~ - I~ ¢ Deep Trench D Shallow Trench D Bed D Mound ~ Other_ Total Depth from original grade: LEGAL DESCRIPTION SoilRating: J' ~ GPD/Sq. Ft. Lot: Block: Subdiv~ion: Deplh to pips bottom from original grade: Gravel depth beneath p~pe ~ ~ ~E~ ~y ~ Ft. ~' ~ Ft~ Township: ~ ~ Range: ~ Section: ~. 'Fill added above originaIo, ~grade: Ft. Gravel length: ~ ~ Ft~ ~ Number of lines: Distance between Ih.es: WELL: Cx,~ New ~ Up~ Gravelwidth: ~ '~ Ft. ~ Classification (Private. A.8.C): ~: Cased To: Total absorption area: Pipe material: Driller: ~ Date Drilled: Stalic Water Level: Installer:~ ~ ~o~E ~t~ Date installed: ¢iel~ I Pump Set at: Casing Height Above Ground: TAN K ~ GPM I Ft. Ft. SEPARATION DISTANCES ~Septic ~ Holding ~ S,T.E,P. To Septic Absorplion Lift Holding ,ublic/Private Manufacturer: Capacity in gallons: From Tank Field Slalion Tank Sewer Lines ~O~ ~¢~ ) Number of Compartments: Well- jori+ jo~.~ ~ ~ ~1~ M~terial: ~ ~ .... su~f~c. ' LIFT STATION Water ~O ~ ]~¢1~ ..... Lot 1~ -- Size in gal,ons: I Manufacturer: Line ~ ~ ~ ~ I ~ Foundation I~I '0'+ .... "Pump on" level at: '~ L~~ High water alarm at: Curtain ~ _~ ~..~ ~,,~ .... p~ctrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: '- Assumed Elevation: /¢¢, 0 Ft. $&S ENGINEERING Inspections performed by'. wo34 .E=¢c m,¢~~~: 1st ~ ~ & ¢~ Eagle River, Alaska 99577 2nd ~/~e/w6 {',¢~ ,o~,, c. cow~N Department of Health~ H~ rvices approval ,,, ~.:'""~ ~,,-.,' ...... ,...," Rev ewed and PP . · 72-013 (Rev. 9/91) MOA 25 Permit No. SW960168 Page 2 of 2 Municipality of Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 · Anchorage, Alaska 99519-6650 · Telephone: 343-4744 On-Site Wastewater Disposal System and/or Well Inspection Report LOT 1, NEWBY SUBDIVISION 015-081-27 Legal Description: PID No.: ~0' UTIL. E_S_M!: ![ A B C ~ FCO 19.0' - 40.0 Ii~T2 18.5' - 66,5 FD 1 7.5' - 68,5 iDBL1 18.5' - 69.5 I DSL~ 19.0' - 70.5 ~01 85.5' 107.5 - -'I 82.0' -- ",, , 1250 G NOGROUND WATER -- Vg.R'I 72-013 A (Rev, 9191) MOA 25 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 PAGE 1 OF ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW960168 DESIGN ENGINEER:S & S ENGINEERING OWNER NAME:DE STEFFANO PETER & MARGARET D OWNER ADDRESS:9620 GROVER DR ANCHORAGE, AK 99516 DATE ISSUED: 7/05/96 EXPIRATION DATE: 7/05/97 PARCEL ID:01508127 LEGAL DESCRIPTION: NEWBY LT 1 LOT SIZE: 90300 (SQ. FT.) HUMBER OF BEDROOMS: 4 THIS PERMIT: 4 THIS PERMIT IS FOR THE CONSTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK SYSTEM ALL CONSTRUCTION MUST BE IH 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 (iSAACS0) . 3. THE ENGINEER MUST NOTIFY DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4744 ( 24 HOURS ) (NOT REQUIRED FOR WELL ONLY PERMIT) 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURPACE SOIL ABSORPTION SYSTEM UNDER CONSTRUCTION DURING FREEZING WEATHER MUST BE EITHER: A. OPENED AND CLOSED ON THE SAME DAY B. COVERED, SEALED AND HEATED TO PREVENT FREEZING 5. THE FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY:~~~ DATE: ROBERT C. COWAN, Ri-_-. ROBERTA. SHAFER, RE. June 28, 1996 CIVIL ENGINEERS (907) 694-2979 FAX (907) 694-1211 HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER&WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL & MECHANICAL INSPECTIONS ON SITE WASTEWATER DISPOSAL SYSTEM DESIGN MUNICIPALITY OF ANCHORAGE Department of Health and Human Services P.O. Box 196650 Anchorage, AK. 99519 REFERENCE: Lot 1, Newby Subdivision Request you issue a permit to upgrade 'the septic system serving the existing four bedroom house on the referenced property. A test hole was excavated and percolation test performed in the area of the proposed upgrade. The approximate location of the test hole is located on the attached site plan. At the time of excavation no water was encountered and atfer seven day ground water monitoring, the monitoring tube was found to be dry. Attached is the proposed upgrade design. We do not anticipate any adverse effects on neighboring wells, septic systems or drainage patterns by the installation of the proposed septic system. The proposed 1250 gallon septic tank is to be placed outside the well protec'tive radius. Attached is a site plan which depicts the location of the proposed tank. If you require additional information, please contact us. Sincerely, Robert C. Cowan, P.E. RCC/gk Enclosure '""~¥r,4L Sc,,, '"'wOo,_ JI/~ ,, '~ u/v/$/o~, u2 1996' 17034 NORTH EAGLE RIVER LOOP · SUITE 204 · EAGLE RIVER, ALASKA 99577 o :::o uu o 0 ~ o~O zm~ ~ z> Z ~ I 0 oc~ ~ 00' D I ~ Z ~ 0 qb oo ~j ~ ~o J , Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG -- PERCOLATION TEST LEGAL DESCRIPTION: DATE PERFORMED: / k,'/~ ~ ~3 'y '¢///~ Township, Range, Section: 1 2 3 4 5 - /,,. 7 8 10 12 '13 14 17 2O COMMENTS ,'"1 SLOPE WAS GROUND WATER I~ 0 ENCOUNTERED? s IF YES, AT WHAT O DEPTH? p E Deplh to Waler After Moniloring? ~ ~ ~/Dale: SITE PLAN Gross Net Depth to Net Reading Date Time Time Water Drop i,~;i7 / ~ /0 ~)~" PERCOLATION RATE TEST RUN BETWEEN __ /' (~ (m~nutes/mch) PERC HOLE DIAMETER ~ '/ CI '~ FT ~ FT AND PERFORMED BY: '17034 Eagle River Loop R6ad No. 204 ~ ' ' . -- CERTIFY THAT THIS TEST W/S PERFORMED IN ACCORDANCE Wll~at~,~.~J~Tatl'~lCt~'l~l[l(~AL GUIDELINES IN EFFECT ON THIS DATE. DATE: ("¢ / ~ '7 ~' ~ 72-008 (Rev. 4/85) ~'-AME MUNICIPALITY O1:: ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAl. PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street - Anchorage, Alaska 99501 Telephone 264-4720 ON-SI'rE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Length 'l-¥pe of crib DISTANCE TO: Class DISTANCE TO: IPHON E g'6-- I '? i6 ]Absorption ~a ~ Inside le n.qth MAILING ADDRESS LEGAL DESCRIPTION LOCATION DISTANCE TO: I" ~ m DISTANCE TO:~® Dwdling g DISTANCE TO:~ < ~%p &F~G G finisl~ ~rade T/z,,u ~3 cO .~cL:c I~ Dwelling Materid -iotal lengtl~b~es --T~-ench width,./ ,~'NEW [] UPGRADE NO, OF BED~.~OMS PERMIT NO. B'q-o 77'7 No. of corq2rtments Liquid depth PERMIT NO. Liquid capacity in gallons Distance between lines 'J tal effeqi~l~tJon area- PERMIT NO. Crib diameter Crib depth Total effective absorption area Well Building foundation Nearest lot line Depth Driller Distance to lot line PERMIT NO. Builc/ing foundation Septictank jjb ! Absorption area(si I IL~ ' OTHER PIPE MATERIALS SOl L TEST RATING INSTALLER REMARKS A ~PROVED DATE [.EGAL L i .-q,v/4 zV~cod? 72 013 (Rev. 3/78) 840 '79 '7 09 / :L 9/84 ~,~1" I- L.[L,~I I]: PHONE ',: TOM SI"{OEMAI<E;R I:::'. Cl. BC)X ;I. :L-.-- 14.3EJ AIqCHOR~GE, ~1'::: 995:[ 1 345- .1. 7 :[ 6 ...EGAI.... DE.':"!iCF~ I I:::':SLIBD ;1: V I S I [tl',l: NEWBY I...OT: ,S1::7.[7F 101',1.: :[ 4 'TONNSH I F",, :I.;:2N. RAI' ',lbE"' ,: 3W ...OT ~ ........ ' ,::~.[ ZI:.~ ,2. ()TA (SQ,, Fl". I]FI ACRES) dAX BIEDF~OOIdS: 4 BL.(]CK: N/A ...isted be].c~w ape 'Lhe C)l:~'t'..:Lcln~.~!; ava :i. ]. ab le 'Lo yc~Lt iii designing y(~t..tp sep'[:i.c i~ys'[eifl. Ct]c:~c]se the cq:Jt:.ion ti']art:, best fi'ts yOLU' ~i'l'..e,, ir !1 . E.... ,, ,.11 ...... )EI:::'TH 'TO F:' ;I: I:::'E BOTTOM (FT,,) 3RAVEL. DEPTH (F:'T. I"l:)'1"~1.~ I}IEF']"H '(I':'T, ) }]RAVI~L.. W I [)'1-1..1 (FT ,, BRAVEL LENGTH (FT',) ~RAVEI... VOL, LJMIE ((3LJ,, YDS,, ) FANI< SIZE (GALS) ~0:[I..~ F~A'f'IIqG (SB~, F:'T, IBR) .... ,:~ ~1, ~L~ i, 5 . ~,,:.-,~ ) 4,, '7 5 28 ,, 4 33 ,, 5 zt.(~. 2 250 ,, 0 .~..~. 1 ~ 250. () .~.~. . 1,250 ,, 0 .~.,~ :t 44 :[ 50 150 '~'~ "I"AI',tI< MUS'T' HAVE A't" I_EAST 'T'WO CCIMI:::'AFI'I"MEIq]'S [ cep'6:i, fy that: :l.,,I am ~,'am:i.].iap with the:.: r'equir'e:men'l:.s for' on'.'..sJ, te seweps and we].].~{; as set eot'th by the Mur~icipa].:i. ty of Ar'tcl"lor'ag(~ (MOA) and the Sta'he c)f Alaska. ~r'ld ir'l comp 15. arlc:g) w:i. th the c:les:i, gn ct' :Ltep :i.a of 'Ibis pst'mi'L,, 2~;,, I wi].l adh(i-me 'h(} al]. I"IC]~ and Sta't.e (:)f Alaska r'e~qt..t:J.l'efller'lts {'(]p 'k.I](~ set bact< dis't, ances f r'om any ex :i. st :i. ng we1 ]., was'Levcat:.er' fl:i. sposal system or, pub].:i.c ~(~Nl;,)l'agle %ysi'k, 6~l CII] 'kh:i.s c.~p any E,U::Ij&YceFIt 81" near'by ].crt.,, 4,, I Lu]cler's'l:.anc:l '[,l"lat:. '[his per'm:i,t :i,s va].id fop a maximum of 4 bedr'ooms E:tnd any er~lapg(z)ment will pequir'e an additicJrh~], per'mit. :F A I...IFT c ..... ]:S ............ -,[ .,,.:.~ orA] ION INF..';]"AI [F::'D IN AN AREA COVEF~tED BY MOA BLJIL.D:I:I',IG "HEN (:1.) AN EL..ECTR]:CAI.~. PERM];T AND :[Iqf:i;F'ECTI :)'4 IdUST BIE (]B]"AINI!ED: (2.) A,.,'e""'L,U.LL.I,,':' ...... (::~ JILL NOT BE AP :'ROVE)]) WITHOUT AN ELECTIRICAL. INSF'ECT];ON F~IEF:'ORT; AND (3) THE ;I..EC]T~-ICAI... WORK IdUS]" BE DOIqE BY A LICEIqSE;D IELIEC'I"IR:[C]:AN. ~ I GNED SOILS LOG MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & DEPARTMENT OF HEALTH AND ENVIRONMENTAL P~(~J:~I~L PRdgq~CrI(~RCOLATION TEST 825 L, Street, Anchorage, Alaska 99501 264-4720 SEP ~ 4 ~984 SOILS LOG - PERCOLATION TEST 1 2 PERFO.MEO FOR: /g/E ~ ~0 ~ L: × SLOPE RECEIVED SITE PLAN ¥~10 11 ~¢_-~12 13 14 15 17 18 19- 20 COMMENTS · ~ = c. ,, ::}'-r- WAS GRQUND WATER ENCOUNTERED? /~/C~ ~ O P. E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop o MtJNI~ :lPA. Ja'f'~F Aix 2HORAGE VIJ ONMENTAL PR(ITECTION ~ SEP '1 :. ~84 RECEtX;ED PERCOLATION RATE (minutes/inch) /, PERFORMED BY: ~ /~ "7" i~' .~ TEST RUN BETWEEN FT AND CERTIFIED BY: 72-008 (6/79) ./ FT DATE: / / {, DEPAI:r':TMENT OF' HEAL.I'H AND ENVIRONMEN]'AL I::'ROTE~C'I'IOI'4 825 L STIREE'¥, ANL,FIJRAGI:., Al< 995()1 264-4'72(:~ AF'PL I C~IqT ~ 'ADDREE;S ." CON]"AC'I~ F'I"E)I',IIE: "rOM SHOEMAKER C/O 'fRS CONSTRUCT];ON PO BI~X ~ 1-1438 ANCHORAGE, Al'::: 995.1. 1 345- 1716 LEGAL DIEE;CR.I:P~ SUBDIVISI[IN: NEWBY L. OT: 1 SEC'TIOI',I: 14 , TOWNSHIP: 12N RANGE." .];W L,,OT SIZE: 2,,07A (E~Q.FT. OR ACRES) uiJ~.~.C beJOW a'u th~.' optiorl.~ availab].e 'to yoLt iii dmsigning yOLH" ~ept~:i.c system. Choose 'El'lB op'Lion tha'L best r J.'Ls yOLtP s~i'be. DEP'TH 'T'O F'IF'E BOT'TCIM (I::'T. GRAVEL DEPTH (F'T.) "I"OTAL, DISPTH (FT.) GRAVEl.. W I If!TH GRAVEl.,. I...EIqGTH (FT.) GRAVEL VOLLJME (Ct.I. YDS. ) TANI< SIZE (GALS) SOIL. RATING ./ [ L.OCI<.. N/A *.x* TANI< MUST HAVE A]" LEAST TWO CDI'flF'AIRT'MENTS I cer'LifY ti'la'L: J.. I. am {ami].iar w:Lth 'Line r'equ:i.r'e.m~m'Ls for orr..-s: d w~].ls as se:L' fc]r, tl-i by 'Lhe Munic:Lpal:i. ty of Anchorage (MOA) d the Sta'Le of Alaska. 2. I wi].l :lr'lstall tine system in accordance w:i,'Lh all MOA c:(~des and r'egu]:at,:Lons;, . and in c~mpt:i, anee wStl"l the desSgn criteria of thi~ perm:i.t. :3,, I will adhere t.o a11: Id(]A and State oF Alaska requirements For 'Lhe se'b ba(:l.:: distances from any exif.~ting we].l~, ~astewa'Ler disposal system or public sewerage sy!!FL6~m ol"l 'Ll"lJ.s oP arly ,~d.jaE:ef'lt o1' ,r!earby ].~'L. 4,, I understand tha{~ 'Lhis permit' J.s va].id For ~ ~laximLt~l o[' zJ. bedrooms arid any enlapgement ~i].l require an mdditional p~r'miC,, IF' A I...,IFT ST~¥T]:ON IS :NEj~AL_ED I xl Ahl AREA CDVEREED BY dOA BLJ '1 D]'NG CDDI::S. WII...I~, NOT BEE AI::F:'IR%~D W]:;f~][.I]" AN~.ECTRICAL ]:NSPEC]"ION 'REF'ORT~ ANT) (3) THE ....... x ............ ............................. ,:,-::, .......... APPL.:I:CANT: T(.~ SHOEI~AI<EF~ C/0 "FF~S CONS]'RUCTION 4 · '"¢ ............................. ........ ~ ...................................... : .............. : ........................ , ............ ':'~'T ....................... WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of 6eologicBI & GeophysicBISurveys NOI,[D~U, Oaa 1V./NaWNO;dlAN-3 iiIB'C~)I'DN¥ -40 ,U. IWdIDINnI~I Orilling Permit No, LOCA'I'ION OF WELL (Please complete either la~ lb or lc.) A.D.L. No. Lot B2 M '/4gtrs. Section NO. TownehiPN[_-] Bange Emi Meridian j _of_et__o,__ sO wO Surface q ¢ Z 6. ~Cob[e ,ool ORot°ry 0 ,riven 0 Dug 8. CASING: 0 Threa~d ~ Welded ~ Above or ~ Below lend surface Equipment used: [~ ft. otter ~ hrs. pumping ~ g.p,m. PU 6 LEVEL below lend surfooe and YI D ft. after hfs, pumping ~g'P'm' 12.GROUTING Well Grouted: ~ Yes ~'No 13. PUMP: (if available) HP Length of Drop Pipe ff. capacily g.p.m. ~ Subm. ~ Jet ~ Centrificol ~ Other 15. Waler Temperature ~o ~ F~ ~ C '~ontract License Number Authorized Repfesenlative Copy Dislribulio~; WHITE-Slate DGGS~ PINK-Driller~ CANARY-Cuslomer Street Address and Area WELl_ LOG 16, WA]ER WELL CONTRACTOR'S This well wes drilled MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONM~NTAL ttEALTH DEPARTMENT OF HEALTH AND ENVIRONM~NTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legal Description (include log, block, s,ub~ivision, section, township, range) Location (address or directions) (b) Applicants Name //~'~.~,--df _~..~/.?o~,~ Applicants Address_ 7~ ~ / l~'C~mO.~7~ (c) 4ppli~ant is (check one) Lending Institution ?uy rElll; Other , (e plain); (d) Lending Institution Telephone - Home Business ~ ; Owner/builder ~; Telephone Address,' (e) Real Estate Co. & Agent Address Telephone (f) Mail the H~ to the following address: 2. %ype of Residence Single-Family~ Number of Bedrooms 3. Water Suppl~' Individual Well~ Other (describe) Community~ Public~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status, .Sewage Disposa1 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] 5'. Engineering Firm Providing Inspections~ Tests, File Search, Data and In/ As certified by my seal affixed hereto and as of the validation date shoW~ .verify that my investigation of this Health Authority Approval shows that the 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, ~ baaed on the information ebtained from the Manicipality 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 ~C-~. ~'-'~'Z~. Telephone ~'~/- Address ./~2~ ~ ~'~ il 6. DHEP A~.proval Approved for A~c~ bedrooms · Approved .~ Disapproved Terms of Conditional Approval Conditional CAU£ION TIlE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DttEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN lin PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ~ASKA, THE DHEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY 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 SF~) RR4/eJ/D18 [Page 2 of 2] 7-19-84 ALASKA ~nulBonm~nTAL COnTBOL 1200 ~est 33rJ AuCnu¢. $uii¢ B* Anchorage, Alaska 9es03 .(907)~}~o~d qVZN]WNOalAN~ " b~.qdNICIPALITY OF ANCHORAGZ DIVISION OF ENVIRONbiENTAL IIEALTH DEPAJ{T~-iENT OF HEALTH AND ENVIRONM]gNTAI, PROTECTION APPLICATION FOR HEJCLTH AUTHORITY APPROVAI, 6q~RTIFICA%% 1o General Infomnation Application Data /.~-[~fi~ (a) Legal Description (include lot~ block, subdivSsion, secgion~ ~ownship~ faille) ' :.4 ~ /~,A':: i: ~? /.~.~,.&.: ~.~.!,.,.:~/~,~... ~'/.~?'~/. l?' Location (address ~ directions) Applicants Address (c) ADplicant is (check one) Lending Institution (d) Lending Insti~ution Addz'es s ' 1 T e_epho ne (e) Real Estate Co, & Agent Address (f) Telephone Mail the HAA to t'h.e following address: 2o Tjy~p~ of Residence Single-Family [~::- Number of Bedrooms 3 ~ Wa t er S~utpl~y" Zndivid.~al Wall 127X " Other (describe) Community [~[ Public Note: %f coramunity well syste~, must have written cor~im~mtion from the State Department of Environmental Conservation attesting to the legality and sterns,, Sewage Disposal Onsite V~' Public [~q Comm=ity [[7~ Holding Tank [~l Note: If community well system, must have ~ittan co~i~mation from the State Department of Enviror~ental Conservation attesting to the legality and status~ [Page 1 of 2] 5o Ensineering Fizva P..ovid~ng Inspections, .[e.3ts, 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-siLe water supply and/or w-astewater disposal system is safe, f~ctional and ~equate for the number of bedrooms and type of structure indicat~ herein.- I further verify that, based on the information obtain~ from the ~nicipality of ~chorage files and from my investigation and inspection~ the on-site ~ater supply and/or. ~sgewater disposal. system is in compliance with ~1 Municipal and State codes~ ordinances~ and regula'- tioas in effect on Che date of ~his inspection. / ..- , fl._ f .. ' Approved ~_~ Disapproved ..... Coraitioual CA~fION ENVIRO~ P~OTECTION TLiE MIINICIPALITY OF ANCHOIL&GE DEPAR%l~Ebr£ OF REALTH kND (DHEP) ISSUES I~U~:A~LTR AUTHOIiITY APPROVAL CERTIFICATES BASED SOLELY UPON TIlE REPRESENT= ATIONS GIVEN IN PARAC;RAP!I 5 ABOVE BY AN INDEPENDENT PROFESSIO~kL ENGINEER REGISTERED IN TEE%~ STATE OF ALASKA. THE DHEP DOES %~.IS AS A COURTESY TO PURCILtSERS OF ZOMES AND TILEIR LENDING INSTITUTIONS IN ORDER TO ~A_iSFY CERTAIN FEDERAL AND SL~.IE REQUTRE~ i~ZNTSo E%4PLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED° THE MUNICIPALI'£Y OF ANCHO[UIGE IS NOT' RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROIEoSIOMkL ENGINEER'S WORK° (DHEP SEAL) ~4/eJ/Ol8 [Page 2 of 2] 7""19 -~8A M C P L TY OF ANCHORAGE (MO ) HEALTH ALrfHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 Total Depth' [0~t Cased to_ /04/ Depth of G~outing~}D~b,~2~J/oT,. Static Water Level ~-S~"' Pump Set AtR)o~ O~'bl bO~"~[[ /07 Casing Height Above Ground ~.(p ! Sanitary Seal on CasingS/N) Electrical Wiring in Conduit ~) Depression A~ound Wellhead~N) Separation Distalcms f~om Wall: To Septic/Holding Tank c~ Lot //~ L ~ ; On Adjoining Lots '"<'~i Ne~st Edge of Absorption Field on Lot //~ / ~ ; On Adjoining Lots T6 Nearest PUblic Sewe~? Line /~7~ To Nearest Public Sewer Cleancut/Manhole_ /~ To Nearest Sewe= Service Line on Lot Wate= Sample Collected By ~. ~ ; Date Wate~ Sample Test Results ~'~_~-~7~c_~f2~~ .... .'~ , % ' B. SEPTIC/~OLDING TANK DATA Date .Installed /(~)~/~/~ ~d( Si?~ !~ ~ Dep=ession ove~ Tank ~Y~/N) p ,, Date Last Pumped NO. of Co~oa~tments ~ Foundation Cleanout ~) Pumping/Maintenance Contract on File .(Y/N) ~ ; for Holding Tank High-Wate~ Alarm (Y/N) /~ Tempo~aI~; Holdinu Tank Permit (Y/N) /3> SeparatiOn Distances f~cm Septic/Holding Tank: To Watar-Supply W~ll_ ([~ To Property Line /dP To Water Main/Se=vice Line To Building Foundation /~- TO Disposal Field ~/ To Stream, POnd, [~ke, c~ Major D~ainage Receipt #. Date Paid- ~ount: [Page 1 of 2] 2-15-84 ABSORPTION FIEID E~TA Soils Rati~g in Absorption St~ata /~)~ Type of System Design. Date .Installed /~{~~ ~'~. Length of Field ~-/ Width of Field ! Depression ove~ Field (Y~ Date of last Adequacy Test Results of last Adequacy Test ~/~4 Separation Distance f~c~ A~sorDtion Field: ' ~'~' To P=operty Line ~ To Water-Supply Well Depth of Field /~ ~ Gravel Bed Thickness ~' Standpipes P~esent ~/N) / TO Building Foundation Lot ~ ; On Adjoining Lots ~/'~ To Wate~ Main/Service Line .pt To Cutback(if present) ////~ To Stream/Pond/Lake/o~ MaJo= D~aina~e C~urse To D~iveway, Pa~kir~ Area, c~ Vehicle Stor~age Area . /~ To Existing or'Abandoned System Ch D. LIFT STATION . Date Installed .xxDir~e ns ions / // "~ ~" ~1 at . "~f" ~vel at High ~ter ~ ~vel at './ .... Vent (Y~)' Tested fo~ g Cycles ~ing Adequa~ ~st. ~ets ~A Elec~ical Co~s (Y~) C~nts ~/~ ~tify that I ha~ ~ecked, m~ified, ~ ~nf~d to all ~)A ~ ~i~lims in effect on the date of this inspe{~ion. Signed~_~ ~ +~ ~*~ c pop .~' ~'~~-- Date [Pa~e 2 of 21 2-15-84