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HomeMy WebLinkAboutPARK HILLS #1 BLK 1 LT 3Park Hills #1 Block 1 Lot 3 #017-142-06 Municipality of Anchorage Page ! of 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: S 4o g3 oc> q9 PID Number: (-') 17 1 LIZ 6 Name: Wastewater System: [New ❑ Upgrade A 2� 7— �D t t 2 Address: :3 ACA Mo A ABSORPTION FIELD Phone: No. of Bedrooms: j� Deep Trench O Shallow Trench ❑ Bed ❑ Mound ❑ Other LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: 6)•93 GPD/Sq. Ft. Qt—(u Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe 3 1 `-PAaKfjt-Ls 1 q` -(p" Ft. s - Lo Ft. Township: Range: Section: Fill added above original grade: Gravel length:! ( S 1^v0 fv M Ft. { Ft. WELL: NNew El Upgrade Gravel width: Number of lines: Zt Distance between lines: Z1—O Ft. /Z_0 Ft. Classification (Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: t V ATCs 1/98 Ft. &4 Ft. Roe) SQ. Ft. 3 0 3 4 Driller: Date Drilled: Static Water Level: Installer: Date installed: ,AIPrt4eC aL2l.LLIAXI. -1 1 /30 Ft.mike- Anme�aso►A Yield: I Pump Set at: Casing Height Above Ground: TANK GPM lb Ft. Z S Ft. SEPARATION DISTANCES Speptic ❑ Holding ❑ S.T.E.P. To Septic Absorption Lift Holding Public/Private Manufacturer: Capacity in gallons: From Tank Field Station Tank Sewer LinesZ / Zsv Well I c;0 t N /i4 N Material: Number of Compartments: C�-4- [ 4t S7 2— Surface N1A N/A LIFT STATION Water Lot ZL77 r 2�� Size in gallons: Manufac r Line Foundation `�^zt r C( 0 "Pump on" level at: u p fY' level at: High water alarm at: Curtain N/6 A. Pump Make & Model Electrical Inspections performed by: Drain (( BENCH MARK Remarks: Location and Description: aAf1Ah9-. L QAh4L .vlbobYa_. Assumed Elevation: t 0c) ENGINEER'S SEAL ' � n S ��p/�n7.17©/JC�r� Co 23 `t3 Inspections performed by: Dates: 1st '°°�°�°°°`° ° ° " �,;w:��.°°��- - t 2nd 10-K7? .-�t3 ,°°..;.°....., •�>�:_�� " 'c Steven R. Pannone a " R Department of Health and Human Services approval 9 —8 Reviewed and approved by: ✓� Date: o �� , 72-013 (Rev. 9/91) MOA 25 y s6 i2C.'D�u �k.P✓ bAT�'n M A '( IIS 1°f 9,3� VSWh TSS-cAet� $�E�� `IJA�"vi 2�� PJ / �� \ & ( Fj /co ; § . Ll :.�,r {/g � y� �� 0- d J v) n 0 Q-VS7 4 i u 0l4 7 Jr••ab ��5.' i �`�`e a' u • �� LO pp Luo c 6���a�h Nll ••� S =•E44•• � H.Y ® �1 (pw�.p•�p11,y1 yy�yw .i '7 `: i ... .. r.. .,r+.. r N r- ',k• , S. fIf' ..... i. y.,.r.... e:°'r' y -- ±)nN". Stl?a STATE OF ALASKA DEPARTMENT OF NATURAL AMURIS B DIVISION OF WATER, WATER WI LI. RECORD F. A M OLL ildiptlOH t!D N LOT Bt.00K NOTION OTRS I SXTION TOVYw"P R"OE I rp aN of Os Ow; ;. mere": ",r, i -1 'v1 ;` ! rrir WELL OWNER: ' 6•,r�rlrrc I . .j --lit.:, gMFASURED FRDM:Ocas,ng top Oground surface WELL DEPTH: PATE OF L . OLE DATA: Depth Depth of hole: wo ft p ng: ft �l�l Depth of eesl 17V" and Color From To s `.:: •' !, � f . DEPTH TO srarlrr WATER LE9►EI.. bolowxtop of casing ©ground`> hrtaodl i' Date: j afASTHOD OF DRILLING. air rotary U G" 1 II otter rItA J Cr . USE Of WELL: domestic O irrigation 0 mot or 'S ! D [� Polio supply O other I . CASING STICK ;. . �; 1 ft. Diem: f l 1 cc . tn1J Casing type r IM ' WELL INTAKE OPENING TYPE:( open end O perforated O open hole "' l`•: Depth$ of openings: to -ft -ft i SCREEN TYPE: Alam:_O SiotlMaeh Size: IN. (TRAVEL PACK TYPE,RE Volume used: Depth to top:. - S I GROUT Volume- ... froP� Depth: from ft to . i i, DEVELOPM@NT METH D: Niurue ;ais: al rinci1 rage Duration: ep . ea uma i'.:.., PUMPIN¢ LEVEL AND YIELD: ft after hrs pumplr>g PUMP INTAKE DEPTH: ft HorsepOwert I ;ii WELL 01$INF64TRD UPON COMPLtTI0N>' CTOR INFORMATION: I. ' RtO11fARKS:ot us�f+es ams " �.. PLEASE MAR WHITE COPY OF W19410: 'ire -- „ ONFWIVISiON F WATER 6t g Of AUt or ze espr9aeniat ve etc PO SOX 772116 EAGLE RfVER AK 99577-2116 I; , MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND HUMAN SERVICES P.O. BOX 196650, 825 "L" STREET, ROOM 502 ANCHORAGE, ALASKA 99519-6650 ON-SITE WELL AND WASTEWATER DISPOSAL SYSTEM PERMIT PERMIT NUMBER:SW930099 DESIGN ENGINEER:USKH ARCHITECTS ENGINEERS OWNER NAME:BARRETT EDDIE R & BARBARA J OWNER ADDRESS:3605 ALAMOSA DRIVER ANCHORAGE, AK 99502 PARCEL ID:01714206 LEGAL DESCRIPTION: PARK HILLS #1 BLK 1 LT 3 LOT SIZE: 42738 (SQ. FT.) NUMBER OF BEDROOMS: 4 THIS PERMIT: 4 I THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD /SEPTIC TANK / WELL SYSTEM ALL CONSTRUCTION MUST BE IN ACCORDANCE WITH: tour, 1 yr 1 DATE ISSUED: 5/12/93 EXPIRATION DATE: 5/12/94 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 DHHS AT LEAST 2 HOURS PRIOR TO EACH INSPECTION. PROVIDE NOTIFICATION BY CALLING 343-4329 OR 343-4681 AFTER BUSINESS HOURS 4. FROM OCTOBER 15 TO APRIL 15 A SUBSURFACE 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 --� DATE: ISSUED BY: a �/ '"``�` DATE: Z 6) �--e fps � .� 67,,�- Dear DHHS, The first submittal for this septic design required redesigning due to the high water table (6 feet) in the tube, but the owner still wants a deep trench system therefore the alternate test hole done by Lee Reed will be used a the site for the septic system. The test hole with the high water table will become the reserve area , possible bed location. The water level in the test hole from Lee Reed has been recorded for the past 2 weeks with the elevation changing almost daily. The owner has informed me that he thinks the neighbor is dumping water in the test tube to stop development on the lot. The water table is at 12 feet only for a short time then drops to no water in a 12 hour period. This is not normal for a water table therefore I will design the system around the test hole being dry to 13 feet as stated in Lee Reed's perc test. As of this morning the test hole was dry. Sincerely Steven R. Pannone P.E. r - PO May 11, 1993 Department of Health and Human Services yo,„ Anchorage, Alaska � 3 Ne Re: Onsite Sewer system design for the Eddie Barrett m Park Hills Subdivision Lot 3 Block 1 f0N Dear DHHS, The first submittal for this septic design required redesigning due to the high water table (6 feet) in the tube, but the owner still wants a deep trench system therefore the alternate test hole done by Lee Reed will be used a the site for the septic system. The test hole with the high water table will become the reserve area , possible bed location. The water level in the test hole from Lee Reed has been recorded for the past 2 weeks with the elevation changing almost daily. The owner has informed me that he thinks the neighbor is dumping water in the test tube to stop development on the lot. The water table is at 12 feet only for a short time then drops to no water in a 12 hour period. This is not normal for a water table therefore I will design the system around the test hole being dry to 13 feet as stated in Lee Reed's perc test. As of this morning the test hole was dry. Sincerely Steven R. Pannone P.E. r - .1k „ , % AO el If Aj ADO 17 160, All of A 4C Ar TH move ................ .22 1 April 20, 1992 Department of Health and Human Services Anchorage, Alaska Re: Onsite Sewer system design for the Eddie Barrett Park Hills Subdivision Lot 3 Block 1 Dear DHHS, This is a request for an onsite sewer permit for a new residence located at the above address. The soil was originally tested by Lee Reed in 1984, which showed the lower section failing and the upper passing ( see attached logs). Lee did not number the hole that failed. No water was detected in the upper test holes that Lee performed thru June 13,1984. One additional soils test was performed for the new owner at the South -East corner of the lot, and showed approx. 18 min/inch percolation rate (see attached log dated 4!7/93). The water table was monitored for seven days and no ground water was detected. The water monitoring will continue through the wet season (May) and if any change in the water table is detected, the Department will be notified. The system most likely will not be built till June, when the building permit is obtained. No impacts to the surrounding properties are foreseen. All have onsite systems already and appear to be performing adequately. The required set -backs and reserve areas are easily obtained due to the large lot size and good soils. The wet area on the West side is small and will be the location for the well in the vicinity of the neighbors well. I do not like to see the well down hill from the septic system but the water table is at approx. 150 feet below ground level and the well will be located greater than 100 feet away. Contamination is not likely to occur. The topography of the area is flat on the East side to about the mid- point of lot and then sloping approx. 25% down to the West. The lot footprint is pie shaped, with the East side being the wide section and the West being narrow. Sincerely Steven R. Pannone P.E. N 1 (2-1Ver�_O✓t AV-c-nU� T y. �-- lot 0 L -m too c, (s, Al I �P 4 v oseooril rQ y i IIII I I -��a tial n 0 o i pr.�� II I PpoFlt d: I ! P I iA-�ef , i I I � f� I G Y1 � II I I I � I I I SO $GA I I r IOFi I I I ' I: s - 9 one I CE- 8149 I i i I I Municipality of Anchorage K DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: L1 T Y -C-7�74- DATE PERFOR"`e•�m ]z v� / �' � � v (minuses/inch) PERC HOLE DIAMETER LEGAL DESCRIPTION: Pa( Township, Range, Section: O DEPTH �la Q C k l/ c N i v n 5 3-o w L SLOPE SITE PLAN (FEET) '-✓0 a lfo 1 ©L 4,>, [ 5 2 3 GM st 14-11) 4 coo v 5 i ✓1 i�. w1 �. . 6 7 8 9 '10 11 12 13 14 15 16 17 (34 H r^ u � 40(e-1 18 19 WAS GROUND WATER iENCOUNTERED? IF YES, AT WHAT DEPTH? O S L C P E Depth to Water After Monitoring? 141, CqN Bate: iy Q 1•s 1n_ `f t Q f G if 3 Reading Date Gross Time�Km Net Depth to Time61'tiin Water Net Drop�N yza� e�scpo / �' � � v (minuses/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND u` S FT O -r�c r i L c`ew rt 4 fl �la Q C k l/ c N i v n 5 3-o w L Pu+2 — �o-J �,prne� n ds '-✓0 a lfo 50 loo Y 20 PERCOLATION RATE / �' � � v (minuses/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND u` S FT ;OMMENTS /moo C -e- -r�c r i L c`ew rt 4 fl �la Q C k l/ c N i v n 5 3-o w L Pu+2 — �o-J �,prne� n ds PERFORMED BY: tA,-hoC( A n L�C4.t7V1 I S�•V�K i�-PELNNcwv CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) n MUNICIPALITY OF � N"HCRAGE v jRf DEPARTMENT OF HEALTH AND ENV _ NMC-NT1. PROTECTION TESTOLATION j 825 L. Street, Anchorage, Aluka 4. 501. 26-1,720 _ SOILS LOG — PERCOLA i " (EST PERFQRN1E0 F. OR: pay' Po—'1y1 - DATE PERFORMED:_Ma r d% 22— LEG,, ZLEGE D;F.SCR'PTION: Par }C �1 (I S LO -t S 8j1 q�� _ _ m o N s r 83 6zyC. �SL':PE SITE PLAN Sol) 1jT ` In M) •'furl s'dy 9 does hof' Stije - 6�f- r - 4 Crvfn files -t-Ew�y►, Wins s-f•a.,�d s-�,.,,,9�,.>•, f _, . _ 5 liyh+l roust San 7, i--�-- = Vr 20 WAS GROUND WATER S ENCOUNTERED? L ho1e- on June. F. ' fT IFY YES. AT WHAT �G "�` £ DEPTH? V +�,—OF A444 4 P OV C REID� 1 • R. i M CE - 2251 i SME NEENNE Reading F ;tom' . Gress -� Tim+ Net Time Depth to Water Net Drop f• L S -Y 257 .3. SEEN iA 37 ORENEI � MEIN MEIN r <ll'� ME�E fC .3? .f S- M1001101 SME NEENNE Reading F ;tom' . Gress -� Tim+ Net Time Depth to Water Net Drop f• L S -Y 257 .3. 37 fC .3? .f S- r PERCOLATION RATE_ _ U �Z " (minuteshncN L J , TEST RUN BETWEEN FT 3 f FT COt:.MEfdTS Spt I M 1 �� + % S r�: l n� _ / YQ 0./Z� wnerl f5✓r/ �Sr',_'i�r �ca.� %tel �: �c�o2 c� T fil .� <�. 7�e� �oo1�s 9aa %• %'� PEr`OFjh1F.f- dY: �"�Gt'1 _ _CERT.F Ir gY, DATE:_,__,_.._._.—. f>, 1/nSt !e �e z }rJ+- in �F, _r.'�,'. d� nc7 Fi ,S-rpA�t r(�S7E�'� �T Municipality of Anc n )rardie DEPARTMENT OF HEALTH & ri 1MAN SERVICES 825 „L„ Street, Anchorage, f la .ha 99502-0650 ? SOILS LOCA — PFr%r"�IiTIOIV TEST PERFORMED FOR: �e R�M="n L2`✓"/'H7 -- _ DATE PERFORMED: c/ 1". /9 FG LEGAL DESCRIPTJONiPK/4 HH .S ji1-3 Township, 'Range, Section: 3 y-'i-/2/VJZ- 3k5' SLOPE SITE PLAN I 2 3. 4 I 8 9 16 12 wi 0 L- cfr1aJ;( (4L !; <(+ (�p i 4 Qrtiv�t� 5'e0.✓+t WAS GROUND WP TER �(GS -- -ENCOUNTERED? IF YES, AT WH,,r - j / DEPTH? -- O Depth to Water Atter Monitoring? __ N Q 5-1006 10 L_J G ` PEHCOI.a 1.0N FATE _1. _� (minutes/inch) PERC HOLE DIAMETER TEST RUN BETW EN �� FT AND Z iz FT COMMENTS SO' 1` �ww_ ?s vnr t e b le _ on s le je fi'c. s yd 'cRFORMED BY. ��I- CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFI':7" "ON `,IIS DATE. DATE: :�L `,-�f ¢ Municipality of Anchorage - 0_-. Development Services Department �\ Building Safety Division x 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 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FORA SINGLE FAMILY DWELLING Parcel 1. D, o 7_ t 6" HAA Expiration Date: _� ::Z Q�_1zC 1. GENERAL INFORMATION ` 2. Complete legal'description L_ a i 3� !3/o c/c f Park }Ll(r S /p / Location (site address or directions) l yySo G /a'pn vtw p ,tee _ Current Property owner(s) I v., Sco tf Day phone _Y4_='�o�. Mailing address Lending agency Mailing address Real Estate Agent _-/y.YSO ��len�eew Dri�< Ay+Ghv^ei4k 995"'/ Day phone NO — FS cap Day phone Mailing Address Unless otherwise requested HAA will be held by DSD for pickup. NUMBER OF BEDROOMS: I/_ 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage Community Class Well Public Water System TYPE OF WASTEWATER DISPOSAL: ® Individual On-site �y ❑ Individual Holding tank ❑ ❑ Community On-site ❑ ❑ 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 period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, i verify that my investigation, based on procedures outlined in the 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. NameofFirm Ffatfvp %echn cal Sergi•« Phone__ 3yS- 3�__ Address l yS-3o E, -A- S cti yr e AK 995�� Engineer's Printed Name ') ,AtooPeelf E '"c'e Date _St �,2_ Zoaar 44, UWAP B®C9®80f OO909.11•®IOiO </n s 5. DSD SIGNATURE , ® THEODORE F. MOORE Approved for `T bedrooms. •°0 Disapproved. Conditional approval for bedrooms, with the following stipulations: `J % UN -Si l t_ • "� Additional Comments : m • WARTFWATER Attachments: HAA Checklist X Maintenance Agreements _ Septic System Advisory Supplemental Engineer's Report _ Well Flow Advisory Other Original Certificate Date:__ g By: d� (Rev. 01/02) 1V!4111 1pallty Of Anchorage a° f h 8f�il�a Development Services Department Build'in`g Safety Division pn-,s ox e Vugter $Waste titer Program �" `'" i6'bou�i"iawSf l 1�ncorage AK"9�5I9 X650 ' a �anc"iorage ak us ,'or C pro`vde 1� jq3 Sam ary sea ire Casa v4d6. a',i y :. ... ,r „F'°+i+w'efA_�'v ..Jr "�v"r•'.d" ..vx TI Far ec e Y re gro M 11191 L IyLVl1,YV IMIYf� VF11M r�ri' xz'#"ay':n,"¢"$'��ro�,i"c`TM"..z�.'"x,'Y``< a arias'( -Co Date instatCed, (a ✓ a 3 /g ? t ='« g st>'aar."� tip a, S i .•- a �.; acz `s� ga um er o Compa`rm�ents"�"� C eanou s C n c eanou Y Depression over tank (Y/N) �' Hig water alarm "(1(t�) u e mprng-1- Y°,. ✓ r v .y SoMW `ti�""/ftp or ft�/bdrm) System type ` -Vena 41, ar f � 2 ft "� ��aveT"6e"�oW pips�e s' o `ff Y' '."..ti�'.'�i`$^d.'�'"»,�' 9- S' sorp ion area r ft Monitoring tube Y Depression over field Al a "�"� ,. .-a,: equatyfes i outs ass al ar X07 y bedrooms rm �sorpion ie f 6i in Ce) Wateraddedw gal New depth 601 NNW ime: 1 min Final flw ept�i 5 in. sorp ion rate >= g p ��.x nation treatment past 1 mo) ype Ne o�o �w� �s give a,e nn a '"'",�ah+�., i�"'`i�z "v;+:��a.#�m" "»�?,kh�rA+.�'sw `za��^iii ,4?35 �"aa �a'�'i'a . .k t z.:., ;> r r . „a;: s• .. ., r :'j i(ee f ri G _a S o er S So i(nn rea f� y er e%(e«C cZ n a f5. lir ��/ L�,.�x,��% i'Sr sys/vsn ca,hic%ti., rau✓ec,� ..1�� .�/u, c.! ol.�tR .'., t✓it irla n,/tir au si/o �a �c, �r .fie 6S,"p" �9-% fha l• fres »�o H, o l� G"` C /Pctn 10 Y" /I✓'a� i'�e norJsi -e,7a o� 74e '/+'1n.e,, �nch�a dim f'�jp vuo✓ noJ� ' ,% N'�.,ts^k"T,''',T2`w" TO. Orfiadjacent lots On adjacent lots > ioo line Absorption field= .�I >,4 Qy Number y m s ` fetermined through field inspections and ' m m ° wT records that the above systems are mawm�®®ma..mm�®o.®»�aaam. FOA HAA guidelines in effect on this date. , '- - i �oms sms mss ss ®s. veaess s v�vto�a'€ E Jame T� eo-1or g F. /-Ia 0 r. uocae m CE3589 R . "s®m�m4 m0 mppp@ 'Ir Qy Number 08I27/1999 04:11 9073455577 BARBARA BARRETT PAGE 03 The location Of the tCt�sh�wlOn a fdW (-bu�drawing wings With 78® 21. A MC.5Y.—J1h PLOT PLAN AS BUILT X i I '� � 54"a7Vc l,f LI r+s Lr'StuT. Fa,.t,.,p w�b� 7•rr>wC .CrYAcn�� c?, S. �W, � rx : cX* G'a a J1Os S /.�Onj Op .S oh�ca'o ,,`�y; hayi gym c'' �It /r C r SCALE JLao' GRID 303 i project No. 95_sa) %c @ml lel@�� (� 1731 George Bell Circ e 0 8 abaia Anchoraow et.t... oSrtc .,....,. ..._ _ 1 Hereby certify that 1 have surveyed the following described property: Lot `5—Block 1 .��F3VLt-c,r�i14S»tutf9sal_ e,.K ..e . OF �1r1i4 Recording District, Alaska, and that the improvements situatedP thereon are within the property lines and do not encroach �&.to At"y, A: •• •' • • 'pS°e ••• �V� onto the property M / adjacent thereto, that no lmprovcenls on the property lying adjacent thereto enoroach on the Surveyed n y}� • '� ! premises and that there are no roadways, transmission tines or other visible oasemeats on said %• •�""" '•• e property except as indicated hereon, 10,C:^-'4 Dated this ehe 2-'—v"De of y --- , 19-2-4, at Anchorage, Alaska It is Kmnwh a a +/ •, L$ - 5202 a ,. t i ••" the respoacibility of thi owner to determine the existence ! •��a•.e••"" r of Nov anR, mmm•. u i MUNICIPALITY OF ANCHORAGE fi • DEPARTMENT OF HEALTH & HUMAN SERVICES] Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 1f2t7 l4Zbl HAA # I-U�"i(fY 2'�ZS 1. GENERAL INFORMATION Complete legal description Lo 3 Q�Lo�iG I—PIaRKt�ILLS Svi�t�.I Location (site address or directions) Property owner T Day phone 263 _-Abg Mailing address & C-AIKOSA `brZ-• Lending agency Mailing address Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: ly 3. TYPE OF WATER SUPPLY: Individual well Community well Public water Day phone Day phone 74 - 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 V, 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 furtherverify 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 S-7EvF— ti* `� �^� o NE— Phone -Z74—b 3 Address W 0•'12,oX /`(2ozS ) /aev 0 c2Ar,z Engineer's signatur __ ___ Date SQ— S—zQ`W 0P �C�aao �, M ,.....•••...... ad 6. DHHS SIGNATURE X Approved for 4_ bedrooms. Disapproved. Conditional approval for Additional Comments 1111TIC -;p\ Steven R. Pannone {E CE -8149 �+a`�� if --p ���a �04., �,0,90 ES51oNaLm� bedrooms, with the following stipulations: r 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. 72-025 (Rev. 1/91) Beck MOA 021 rr Municipality of Anchorage l Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: L-c)T 2 [ cc K ) ` lIy K A LLS'( Parcel I.D. O L4 l yZ 0 6 A. Well Data Well type � VA'rE- If A, B, or C, attach ADEC letter. ADEC water system number Log present (Y/N) Date completed 0-0-93 Driller RA C r.✓(2� Total depth /6 r3 r Cased to 6 q Casing height 2 A 4 L Sanitary seal (Y/N) ^r'LS Wires properly protected (Y/N) YGs FROM WELL LOG Date of test Static water level �3 Well flow Z g•p•m• Pump levell b9 - SEPARATION DISTANCES FROM WELL TO: AT INSPECTION Septic/holding tank on lot / oo -r- ; On adjacent lots Zoo rt - Absorption field on lot /C)O �— ; On adjacent lots lov Public sewer main �✓lA Public sewer manhole/cleanout �f�4 Sewer service line ASA Petroleum tank /t,/yA WATER SAMPLE RESULTS: 11, oz n M Y Z r a�r y O M T `z Cn 0 Vi G) O r" Z Coliform D — r r7 r; —C�, — Date of sample: S—S— 9} N p.m. cr Zoo rt - Absorption field on lot /C)O �— ; On adjacent lots lov Public sewer main �✓lA Public sewer manhole/cleanout �f�4 Sewer service line ASA Petroleum tank /t,/yA WATER SAMPLE RESULTS: 11, oz n M Y Z r a�r y O M T `z Cn 0 Vi G) O r" Z Coliform D — Nitrate C? -/.o Mf/L-- Other bacteria —C�, — Date of sample: S—S— 9} Collected by: /til - A ND 212ZaN/6 S� PANN O N L� B. SEPTIC/HOLDING TANK DATA 0(n Date installed to—z3 -g 93 Tank size /2So Compartments Cleanouts (Y/N) Foundation cleanout (Y/N) Depression (Y/N) High water alarm (Y/N) .N /A Alarm tested (Y/N) Date of pumping At) & Pumper ,4,4A 2 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot /00 On adjacent lots -r Foundation 1,5S To property line �5b -r Absorption field �03 r Water main/service line Surface water/drainage 72-026(3/93)• Front CONTINUED ON BACK PAGE C. LIFT STATION Date installed � Manufacturer Size in gallons Vent(Y/N) High water alarm level "Pump on" level at Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D. ABSORPTION FIELD DATA On adjacent lots Manhole/Access (Y/N) "Pump off" Level at Cycles tested Surface water Date installed l b - z 3 --`?5 Soil rating (GPD/Ft2) O •R System type - -ce u -,u c f� Length e?o Pr Width 2" Gravel thickness Total depth 4-S� Total absorption area 8cx0 Sr' Cleanout present (Y/N) ` &'' , Depression over field (Y/N) /✓6 Date of adequacy test /Ll Results (pass/fail) TA S5 for Water level in absorption field before test AA1A Peroxide treatment (past 12 months) (Y/N) test If yes, give date SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /oc) On adjacent lots _ /oy rt Property line so To building foundation 3 I s� To existing or abandoned system on lot "v l� On adjacent lots Dov Cutbank ,y(A Water main/service line N l A Surface water ��A i Driveway, parking/vehicle storage area _ 2S I Curtain drain E. ENGINEER'S CERTIFICATION Bedrooms I certify that 1 have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of,thio.rtaspection. Signature �R Engineer's Name 1­6aajo_,� WpdNnJNC)Nca Date '_c? Q _ 4� HAA Fee $ Date of Payment Receipt Numberate_ C -76 ]9.A9F MGM' Park F°o� Steven N. Pannone d° C; - a CE -8149 Waiver Fee $ Date of Payment Receipt Number