HomeMy WebLinkAboutSILVER CREST BLK 1 LT 1Silver Crest
Block 1
Lot 1
#015-062-23
Municipality of Anchorage Page —ofd
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ENVIRONMENTAL SERVICES DIVISION
P.O. Box 196650 0 Anchorage, Alaska 99519-6650 • Telephone: 343-4744
On -Site Wastewater Disposal System and/or Well Inspection Report
Permit Number: G\&9qPID Number: 0lam-0622--,�_3
Name: ? Ca Wa,
�...���i r
Wastewater System: ❑ New gupgrade
Address:
ABSORPTION FIELD
Phone:
No. of Bedrooms:
of Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound ❑ Other
LEGAL DESCRIPTION
Soil Rating:
Total Depth from original grade:
O � GPD/Sq. Ft.
I O
Lot: Block: Subdivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe
I S R" S 1
.J Ft.
Ft.
Township:
Range:
Section:
Fill added above original grade:
Gravel length: _
t.� 0
-' i Ft.
Ft.
WELL; El New C1 Upgrade
Gravel width:
Number of lines:
DistaCnccee between lines:
Ft.
I
Ft.
Classification (Private, A,B,C):
Total Depth:
Cased To:
Total absorption area:
Pipe material:
Ft.
Ft.
! D'C) SO. Ft.
C J y �--'
Driller:
Date Drilled:
Static Water Level:
Installer:
Date installed:
'.�'Z[. — ° I t
Ft.
I .C�.-O(, ✓l
,7�`.z
Yield:
Pump Set at:
Casing Height Above Ground:
TANK
GPM
Ft.
Ft.
SEPARATION
DISTANCES
❑ Septic O Holding 6KS.T.E.P.
To
Septic
Absorption
Lift
Holding
Public/Private
Manufacturer:
Capacity in gallons:
195 D
From
Tank
Field
Station
Tank
Sewer LinesNet
t -t 71",zNK
Material:
Number of Compartments:
Welh
l7i �.
� 6
I d z.
�
//
� �e�l
Watere
N
LIFT STATION
o
Lot
// _
_
% tj
Size in gallons:
Manufacturer, ' `
t a.z+�. N=—
Line
l�J
Cl)
�
KiA
Foundation
7v
"Pump on" level at:
2
"Pump off" level at:
L
High water alarm at:
Li �
Curtain1�1
�.
Pump Make & Model
Electrical Inspections performed by:
Drain
I
A
BENCH MARK
Remarks:
Location and Description:
13UIra I�t� 011 g1i l
Assumed Elevation:
i6a,e�
ENGINEER'S SEAL
r
Inspections performed by: Dates: 1st
2nd / 2
Department of Health and Human Services approval
Reviewed and approved by: Date: G
72-013 (Rev. 9/91) MOA 25
I
I
I
NC MARK
SILL
�B
♦ o
♦ REPLACED TANK AND DRAINFI�
/ 1250 GAL STEP
STANDARD TRENCH
I 10 FT DEEP C
7 FT OF ROCK
50 FT TOTAL LENGTH EXIST. TRENCH
04
8 FT OF COVER SWING TIES.,
E ABANDONED AD 0 FT
BD 40.
i AC 35.7
BC 47.5
AE 142,5
-- -BE -118.0 - - -
M Ell
SII
.�T�.,�..
49th
203 W 15TH. AVENUE
ANCH. AK. 99501
LOT 1 BLOCK 1 SILVER CRUST SIDI I SEPTIC SYSTEM AS BUILT
9550 GROVER DRIVE DATE.' JUNE 9, 1999
PHILLIP COWART SHEET: 2/3 GRID: 2439
PERMIT # SW990041 PARCEL 111 015-062-23 SIL01012.DWG
Standard Trenches;
2' Wide
50 ' L ong
10' Deep
7.0' Sewer rock
3' Co ver
Silt Borr;er
70 Ft of Septic
Effective
NO SCALE
1
49th
TODPEN SPURKLAND
No, CE -2225
vo
Air
c
0
1:
cs
a
c
0 0 0
1250 GAL STEP TANK
IVU 3LMLL
BENCH MARK.- DOOR SILL
ASSUMED ELEVATION: 100.00 FT
TUBBEN SPURKLAND P.E. LOT I BL 0 C I SIL WR C`RErS'T SEPTIC SYSTEM AS BUILT
203 W15th Ave 9550 GRO VER DATE. JUNE 9, 1999
Anchorage Ak 99501 SHEET, 3/3 GRID1 2439
I PERMIT // SW990041 PARCEL ID 015-062-23 SIL01013.DWG
MUNICIPALITY OF ANCHORAGE
Department of Health and Human Services
On -Site Services Program
825 L Street, Room 502
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-4744
ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT
Upgrade
Permit Number: SW990041
Legal Description:
SILVER CREST BLK 1 LT 1
Design Engineer:
0007 Tobben Spurkland, PE
Owner Name:
Phillip Cowart
Owner Address:
9550 GROVER DR
ANCHORAGE, AK 99516-6542
2
Date Issued: Mar 26, 1999
Expiration Date: Mar 25, 2000
Parcel ID: 015-062-23
Site Address: 009550 GROVER DR
Lot Size: 50861 SQ. FT.
Total Bedrooms: 3 Permit Bedrooms: 3
This permit is for the construction of:
❑✓ 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 DHHS at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-4744 ( 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:
Date:
i
Issued By: �iLt.(� 4 Date: -2 K —
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 1 BLOCK 1 SILVER CREST S/D
PHILLIP COWARD
Municipality of Anchorage
Department of Health and Social Services
820 I Street
Anchorage, Alaska 99501
RECEIVED
MAR 16 1999
MUNICIPALITY OF ANCHORAGE
ENVIRONMENTAL SERVICES DIVISION
March 16, 1999
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 16 ft.
Use Standard Trench with STEP tank
Soil Rating. From Testhole 3/3/99 6 min / inch
No. of Bedrooms 3
Required Area per Bedroom: 187.5 sq ft
Total area required: 187.5 x 3 = 562.5 sgft
Testhole depth 16 feet
Bottom Rock At 10 feet
Top Rock At 3 feet
Rock Depth 7 feet
Total Trench Length 563 / 14 = 40.2 ft.
USE 50 LP'
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH
50
FT
TOTAL WIDTH
2
FT
TOTAL DEPTH
10
FT
ROCK DEPTH
7
FT
COVER
3
FT
SEPTIC TANK
1250 GAL STEP
The installation of this septic system will not prevent wells 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.
C�
O
LFd LOT I �j y�e11
I
\V � I
3A \ \ S
LaT IS I
car
e
.0N7
I J / J2 L
. @ LOT 1
100
---__ --- ---__
----- -- NEVBY AVC.
2A ----
S�e11
OFAW
0,
2B ■49�h
N �'.� TO BEN SPURKLAND ;AV�
�j C,�J,T�•• No. cE-2225AV
,1� F� •................'••�F�i
44 /%DFESS0'
�I
50 0 50 100 150 200 250 300
SCALE- 1 = 100 FT.
TOBBEN SPURKLAND P.E. LOT I BLOCK I SILVER CREST SID SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUE 9550 DROVER DRIVE DATE: MARCH 3, 1999
ANCH. AK. 99501 PHILLIP COV/ART SHEET: 1/3 GRID: 2439
(907) 279-3916
SILOl011.DW6
PERMIT # SW990XXX PARCEL ID 015-062-23
Z0000** 00
toto
♦ REPLACE TANK AND DRAINFL
0 1250 GAL STEP
STANDARD TRENCH
♦ 10 FT DEEP
♦ 7 FT OF ROCK
0000, 50 FT TOTAL LENGTH
JJ2
\11
25 50
SCALE: I",
_
TOBBEN SPURKLAND P.E. LOT I BLOCK I SILVER CREST SID
203 W 15TH. AVENUE 9550 GROVER DRIVE
ANCH. AK_ 99501 11 PHILLIP COWART
PERMIT N S W990XXX PARCEL ID 015 -
SEPTIC SYSTEM DESIGN
DATE: MARCH 3, 1999
SHEET: 2/3 GRID: 2439
SIL.01012.DWE
0
118' HOLES AT 30"
Standard Trenches -
2' Wide
50 ' L ong
10' Deep
70' Sewer rock
3' Co ver
SN t Borrie
70 Ft of Septic
Effective
NL7 SCALF
cam.,.• L •1
49th °.
^�. TUBBfN SPURKLAND j
JF
✓f No, CE-2225_�
v
�s x...........C C5
#444%14 S0
0
a
s
0
0 0 0
1250 GAL STEP TANK
/VLI 3CHLL
TOBBEN SPURKLAND P.E. I I LOT I BL0C`Il I SIL VER CRE I SEPTIC SYSTEM DESIGN I
203 W15th Ave DATE MARCH 16, 1999
Anchorage Ak 99501 9550 GROVER
SHEET: 3/3 GRID
I PERMIT # SW9900XX PARCEL ID 015-062-23 SILOl0I3.DWG
Muni-1pality of Anchorage
DEPARTMENT OF -IEALTH & HUMAN SERVICr_S
825 "L" Street, Altchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: 4 I,: LL, I Ca l,�
(ENGINEER'S SEAL)
DATE PERFORMED: 2/-6 1 l I
LEGAL DESCRIPTION: List `r" 1, 3 V. I 3 j j,_-., _wyr ownShip, Range, Section:
SLOPE SITE PLAN
EP H
( ET
1
2
3-
4 i s
5
6
7� t L
8 G >ra
U
9
!'
10 WAS GROUND WATER n I
p
ENCOUNTERED? _
11
IF YES, AT WHAT
DEPTH?
12
ge 8• to Water Aller
N 3
13 Moailonng) ►'V gate: —1
14
15
16
17 14 t
6kole—
IN
S
L do
Po Lesto(.r
E
Feading Date
Gross
Time
Net
Time
Depth to Net
Water l�loa: Drop
SDAC>e
ta2t
d
3�
( I5
—
z
--
4 -S
— t ,
%r Z
7 0
o
SC>
,L �1
7%
.�
20 { t(
uPERCOLATION RATE 1:2 (minutes/inch) PERC HOLE DIAMETER
TLST RUN BETWEEN (4v FT AND G Z- FT
DISCLAIMER Groundwater conditions indicated are for the dates shown only.
Past and future presence and/or depth of grot,ndwater can not be predicted
romese o serva tons.
PERFORMED 9Y: �� � ,...._ ig " _ CERTIFY THAT THIS TEST WAS PERFORMED IN
J
ACCORDANCE WITH ALL STATE AND MUNICIPAL GLAL ELINES IN EFFECT ON THIS DAT P.. DATE: -'5-' L 1 p
72.008 (Rev. 4185)
�1 H 44
Munl.iF allty of Anchorage
DEPARTMENT OF iEALTH & HUMAN SERVICES
825 "L" Street, Altchorage, Alaska 99502-0650
SOILS LOG — PERCOLATION TEST
I"
PERFORMED FOR: I ✓st��l✓ Co
LEGAL DESCRIPTION: Le
DEPTH
(FEET)
1
2
3
4 d✓'e—V[$e-
5
6 do L"
8 - C
9
10
11��
12
13
14 a
15
16
17
18
19
20
(ENGINEER'S SEAL)
3
_ DATE PERFORMED:
c4"' Township, Range, Section:
SLOPE SITE PLAN
WAS GROUND WATER
ENCOUNTERED?
IF YES, AT WHAT
DL'F"rH?
0411- to Water Aller
Moallaring7 __
S
L
O
_ P
E
Oaie:
F'eading Date Gross Net Depth to Net
Time Time Water Drop
PERCOLATION RATE (mnulesimch) PERC HOLE DIAMETER
TLSI" RUN BETWEEN FT AND FT
DISCLAIKLR— Grnu�t"Pr c;lnditions indicated are for the dates Shown only.
Past and future presence &nd/or depth of gro,.ndwater can not be predicted
rom these observations.
PERFORMED BY: ,.._— I .._ CERTIFY THAT THIS TEST WAS PERFORMED IN
ACCORDANCE WITH ALLSTATE AND MUNICIPAL GO!� ELINES IN EFFECT ON THIS DATP. DATE'
72.008 (Rev. 4/85)
I
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
JIM Ro%t%n savj
PHONE
2 f z QST (
❑ NEW
'KUPGRADE
MAILING ADDRESS
9"-0 /ke-/ior yt- Blaska %95 O4
LEGAL DESCRIPTION
�ve�(rest fjl,EE l LurLJ 5e�z`I 7'1i6.f1113w
LOCATION
S G G„sve'
NO. OF BEDROOMS J
Uy
DISTANCE TO:
Well
Absorption area
Dwelling
PERMIT NO.
a 2
wr
Manufacturer
Material
No, of compartments
N
Liq. capacity in gallons
IFOMEMADE:
Inside length
Width
Liquid depth
®2
J V'
DISTANCE TO:
Well
Dwelling
PERMIT NO.
Oa z FQ-
Manufacturer
Material
Liquid capacity in gallons
O
J y
DISTANCE TO:—
Well/00Foundation
Z 7't-U
Nearest lot line
PERMIT Ng
S S o y0 3
J w z
F-
No. of lines /
Length of each line
25-
Total length of lines
2,3C)
Trench width
inches
Distance between lines
/V/{
I-
O
Top of tile to finish grade i
B
Material beneath the f
'ILIne+ies
Total Uefpffective absorption area
16 *
w
(7
Length
Width
Depth
PERMIT NO.
Q I-
Lu
Type of crib
Crib diameter
Crib depth
Total effective absorption area
wWell
DISTANCE TO:
Building foundation
Nearest lot line
a
r
Class
Depth
Driller
Distance to lot line
PERMIT NO,
W
DISTANCE T0:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
o
PIPE MATERIALS
r- $le L72-,?29
\\
SOIL TEST RATING
17-x' 0' I b (Perm r) 16&d/bLA Iek�eA
INSTALLER
C,rls CYc.vvi' EX $s-vGG
REMARKS
'sK CreA(-f cii ly 7ikfc, % 21 s,»r z 9 ' c�
yS es!1
J
8e�i�z s r1e.�, Lra.s-i�Flu,tc�.
LL
v
Bx;s'h�
'TonK
1"0A &5`02-`�
Ins eL t7Ed L"arc 13f ,` +'{ C"'(s
Qn
2S`kw9
rj e
25'
�' �5[f�
Ex
fPfeld
` 1,,VtAi
tclaie ' td ; �L� b[tSt� an 'tln
e1ci S'fi� P�pz term i}-> jjo IZ� Lz p� Grc...el= g
APPROVED DATE LEGAL
Jul to V035 SilverCcps"F 'S1ak I Wt Sit, 'X't't1LrJp w
72-013 (Rev. 3/78)
'
P11 4-11 R,,,9 J, IL.": �I F." do ",I L_ 1 0 C3 Fz:" ��P - H C.11 F;�, 0`-� UD
DEF"ARTMENT HEAL'.
H AND ENVIRONMENTAL PROTECTION
825 L STREETv ANCHORAGE, AK 99501
264-4720
PERMIT NO: 850403
DATE I�3SUED: 07/09/85
APPLICANT: JIM ROBINSON
ADDRESS: 9550 ("ROVER DRIVE
ANCHORAGE, AK 99507
CONTACT PHONE, 272-0571
LEGAL DESCRIP: SUBDIVISION: SILVERCREST
SECTION: 14 TOWNSHIP:
LOT SIZ�:.: 50861 (SQ^FT° OR ACRES>
MAX BEDROOMS: 1 �
J.
121\1 RANGE: 3W
Listed below are the options mailable to you
system. Choose the option
that best [its your
^T`U�En. H,%44�U-A
DEPTH TO PIPE: 1.3011,011 (FT.)
4"0
GRAVEL DEPTH (FT")
Q,0
TOT4L DEPTH (FT. )
12^0
GRAVEL WIDTH (FT")
2,5
GRAVEL LENGTH (FT")
8,0
GRAVEL VOLUME (CU^YDS">
6,3
TANK SIZE ([3)ALS>
1,000"0
SO�L RATING (SQ.FT. /BR)
125
** TANK MUST HAVE AT LEAST TWO COMPARTMENTS
in designing your septic
site.
�
'
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"
I will install the system in acc.ordance with all MOA codes and regulationsi,
and in compliance with the design criteria of this permit"
3" I will adhepe to all MOA and State of Alasika requirements for the set back
distances from any existing well, disposal system or public
sewerage system on this or any adjacent or nearby lOt°
4. I under�tand that this permit is valid for a maximum of 1 bedrooms and
any eMlArge0ent Nill 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 UEITAINED; (2) AS~14UILTS
WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPQRT; AND (3) THE
ELECTRICAL WORK MUST BE DONE BY A LICENS E TRICIAN.
SIGNED DATE:
APPLICANT: JIM ROBINSON
�
ISSUED BY DATE:
~Y
~� ~~�_��~���_~____
yJ\. SOILS LOG
MUNICIPALITY OF ANCHORAGE
/� \I DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
OLATION
825 L. Street, Anchorage, Alaska 99501 264.4720
SOILS LOG — PERCOLATION TEST
PERFORMED FOR: Ga-i/S' Lucay ch' y DATE PERFORMED: cJuij lb 1463
LEGAL DESCRIPTION: 113/ Iver Cres'I 2q •r /11,1 (L3 LJ
7n—PtrT1 SLOPE SITE PLAN
or�B.nrc j'O� 1
S 1 l+1 Swh4
.mk' t scnei-
MUNICIPALITY OF ANCHORAGE
DEPT, OP HEALTH &
ENVIRONMENTAL PROTECTION
RECEIVED
kP9ra cPe..
WAS GROUND WATER
ENCOUNTERED?
S
no L —
O
P
IF YES, AT WHAT E
DEPTH?
6" d"c"' e<k hote.
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
Jvty to
■■■■■■■■■■
6
t
I. z3
■■■■M■■■I■
.33
Z
IIz3
,S8
ON■■■■E
It 3y
'3523
■i
.63
-
3
■■■.EMNE
`(
-ffH
1 I
■■.
),v3
.G0
-
4
it 53
«,
'13
t 4
IIS 3
6o
ti
1 zo3
G
`t S
1�
■■i�®�i�ii■ii■�
S
no L —
O
P
IF YES, AT WHAT E
DEPTH?
6" d"c"' e<k hote.
Reading
Date
Gross
Net
Depth to
Net
Time
Time
Water
Drop
Jvty to
t3
6
t
I. z3
.33
Z
IIz3
,S8
It 3y
'3523
.63
-
3
I'13
`(
-ffH
1 I
),v3
.G0
-
4
it 53
«,
'13
t 4
IIS 3
6o
ti
1 zo3
G
`t S
1�
t u3 -
PERCOLATION RATE /l t' -t 3 (0 (minutes/inch) t
rr
TEST RUN BETWEEN 8 FT AND Z FT
p
COMMENTS sol! '�`eS'i rAy'4 6>j wk -s' 125 L1, /h-, AU64 01' -/A e- -Yrevscti wces '9"[od—
'5'"d 64'( Some SM sial w<,r rrfoni so / ru Perk yps'/ /a rs7«K2
j urc MO'4 S'r y 4-0-Z
PERFORMED BY: Y / CERTIFIED BY: DATE: /
su re. W so, /S• Pe, K a4 1 d6 01/4') -71-re n e h ro(e t 9+ne d ua -cGny l y
72-008 (6/79)
NJUNICIPM-rry OF ANCHORAGE:
DEPARTMENT OF HEALTH
F
ENVIRONMENTAL
82 ENVIRONMENITAI. PRG) -I-
-nINC
ENGINVIE I DIVISION
--(,TJ OWUNICiPALITY C;
f..
DEPT.
o2lil..Sweet - Anchorage, Al-,isi(a
99501 Taloqrhonp.264-47M f ION
ON-SITE SEWAGE DISPOSAL SYSTEM
AND/OR VA11-1.1 iNSPEGTION
RF-,,PQR'!;-
-1-IRNEVV.
UPCRADE
MAILING ADDRESS
LEGAL DESCRIPTION
LOCATION
_Ln
NO. OF BEDROOMS
Well
DISTANCE T0: 1 0 Absorption
L
area Dwelling
PERMIT NO.
80c� 4 76
I_ 2
�<
Manufacturer 11
ex
materill
No. of compartments
Lict. capacity in gallons IF HOMEMADE: Inside length
Width
Liquid depth
r) 02
DISTANCE TO: _e;j mg
NO.
_j
0 2 <
X I-
capacity in gallons
Manufacturer
Material
0
_j 2-
W �, U
_jLL2
Well
DISTANCE TO.
No. oflines Length of each line
Foundation
Total length
Nearest lot line
of lines Trench width
rL,;,'d
11
PERMIT
PERMIT NO.
—Distance —btw, ni —lines
H- Z W
I-
Top of tile to finish grade
-?. I
Material heneath
tile
inches
Total effective absorption —ar-
0
inches
W
U
Length Width
Depth
_c�_F
---
PERMIT NO.
< F-
Type of crib
Crib diameter
b ( pti,
I owl effective absorption
area
DISTANCE TO:
V_
oil
Buildingfoundation
Nearest lot )[10
w
_j
W
Class
DISTANCE TO
Depth
Building foundation
Driller
Sewer line
Distance to lot line TNO
Se otict
tank FAI),caption area(s)
OTHER
PIPE MATERIALS
PVC, P&izr Ir 're,,�
SOI L TEST RATING
j
sc�- tz-
INSTA_CLER
r
U
4U.L
REMARKS
kv_
'* 4i A
z�
.1 4 9 T
.................
;h'- N0. 2100 - E
APPROVED DATE
LEGAL
PFUC-PAU F, FtsIiefe 14 �, 18c)
/Z -U 115 tNev. 151 /6)
Municipality
�" f :
nlif
l
Anchorage
825 "L" STREET
ANCHORAGE, ALASKA 99501
(907) 264-4111
G(FORGE164. SULLWAN,
MAYOR
DEPARTMENT OF HEALTI-I AND ENVIRONMENTAL PROTECTION
December 31, 1980
D & B General, Inc.
Post Office Box 10-1349
Anchorage, Alaska 99511
Permit # 800476
Subject: Lot 1 Block 1 Silvercrest Subdivision
A permit issued by this department for well and/or sewer
system has expired as of this date.
Permits are issued on a calendar year basis, as stated on
the permit, by authority of Municipal Ordinance.
If you have drilled the well, a well log should be sent
to this department to document the installation date.
if an engineer inspected the installation of the on-site
sewer system, please have them send us the as--builts for
our files.
If there are any further questions, please call this
office at 264-4720.
Sincerely,
m, AU141
Les N.
Buchholz, R.S.
Senior
Environmental cialist
LNB/ljw
enc: Copy of Permit
SWP/057
�U 1,-.41��I r: -"u P:=i L-. I I- %A (--H F`� ���������
DEPARTMENT |EHLTH HND Et-,lVIF!ONMENTHL TECTION
825 'L' kSTREET/ ANCHORAGE, RK. 995�-L
264-4720
9 4 F—'7 L- 1— ��� RD PA I -T* U---* 1-7= 14 E- F-` ��F-` U-1 I -Y"
PERMIT K0. ( 800476 )
RPPLICANT D & B GENERHL, INC% POST OFFICE EO>:: 99511 349�6965
L 0 C: ATI ON GRgVER DRIVE
LEGAL LOT 1 BLOCK-1SILYERCREST F./D LOT SIZE 51000 SQUARE FEET
TYPE OF SOIL ABSORPTION TRENCH
MBXIMUM NUMBER OF BEDROOMS 4 SOIL RATING (SQ FT/BR90
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
F."R "Y" I. -A =-.; �L,!a �FEE, P -A 11:3 1- 0-4 ;:2 ��F-Ro fq 17H. L- ED EKI=� I- I -A= ',-
]'HE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHIPIF IELD.
THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE
GROUND AND THE OF THE EXCA'v'8TION (IN FEETX
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRHVEL DEPTH IS ')'HE MIN%MUM DEPTH OF GRHVEL BETWEEN THE OUT�HLL PIPE
AND THE BOTTOM OF THE EXCAVATION (IN FEET).
�Q.79 H.J 1 F�! E:: Ej, ����I C -l'". 1-�V-4 K !,-5 1 2� F:--- J- �2!5 F --o L.- L- 0 PA�
PERMIT HPPLICHNT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTALLATION INSPECTIONS OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE.
1 0-4 1 IrA �—=- rl--o I C'--- -1- 1 0 1--q�1-7E, ����I F -.-OF rc.�.
BACKFILLING OF HNY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
`
MINIMUM DISTANCE BETWEEN H WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEm IS
100 FEET FOR H PRIVATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL. DEPENDING
UPON THE TYPE OF PUBLIC WELL.
MINIMUM DISTANCE FROM 8 PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET AND
TO 8 COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 2`0 DHYS
OF THE WELL COMPLETION.
OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE
AVAILABLE TO INSURE PROPER TNSTALLATION.
T "Y ��F:" l �����E=-* LE IR ���
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2� I WILL IN'STHLL THE 5YSTEM IN ACCORDANCE WITH THE CODES.
]� I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE
RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS.
APPLICANT D & B GENERAL. INC.
�-1 :20n3
AND WELLS AS SET
ENLARGEMENT IF THE
1'-J is t I F t=i L.__ T -T" ' r' I'D F=- 1:A 1 A 1- =1-1 t .. i F.? E: -i tai F:=.
DEPARTMEN'" HPAL-T'H 'RW) F NVIRI,'IN ?E_NTf-,I t RTITECT ICIN
>7r='F.F F, APai=Hl:ifc:ru,E,
l •-1 L_ L_ 6 t F •1 I tit f d - =i::1: T' t~ =: E 1.• 1 E:= Fu_ F I---- Fz: Vl T T-
PE_.RMI r NO. C lO - /-30o, _
p,e SAL jY G PH
AF'F'L_IC:fit Jl-
L_OCATICIN DP—I,vF 7/
LEGAL. �_D 1 ULYK 51 lve-r- C vis l0 LijT S T ZE Jr�� D�O •GIJARE FEE I
TYPE OF `,CITE_ ABSORPTION r'_7Ef1/1IS: TR
P?R;; I MUt9 tJI_IhtE:E-R !F F.FDf-:OI?M' • :. ` CI I L. RATING {E !T F- F, F; F? 90
THE REClI I I RE:D -SIZE OF THE SO 1 L FiBSCIRPT I ON SYS, I_EM I'
12- f" L- L=-1'-4 t_i i- E...1,.:: ;), �, ��. C"i F=' Cl-, Ih. I_- %:. F-- F7" -I- �-I -:.:: 7 T
THE LENGTH DIMENSION P; THE LENGTH IN FEET, III THE TF".ErJC:H ISIR DFI=tIrIFIEI_D.
THE DEPTH OF A TRENCH OR PI•E IS THE D `:�TANCE BETWFEN THE SURFACE= CIF= THE
GROUND AND THE BOTTI:)M OF THE E`;CRb'ATION C IN FEET?.
THERE IS NO SET WIDTH FOR TRENCHES
THE G,RA4'EL_ DEPTH IS THE MINIrUIM DEPTH OF GRFIVFL_ BETWE=E:N THE OUTFALL PIPE
AND THE BOTTOM OF THE.: E`<,C:A'VATICIN MN FEET,.
NF-EGl .1 T. P -a F-" lr .- _ ;J
PERMIT ADPL. I CANT HAS THE
f L _;F'r)tl' 1 C; I L T 7'T
D:) I NFOI_ r•1
TH I :• DEF';' RT 11LN T' DrJf-: I NG THF:
TIJSTALLATIOhJ IIJSPFCrIr)tJr,
OF ANY WELLS ADJACE
11T TI.)
THIS PROPERTY AND THE
tJI THBR? OF RES I DEFU_:E:S THAT
THF WELL WILL_
` E EVE.
- -- -- 1` I •.d t= t
�; :-.
'• I F" d '� F='' �� t_' i I CII
F A: - F -a FR L-7 F-: Fr_ t`'
BACKF" I L.L- I NG OF
ANY
.' T SEM•? W I THOI IT- FINAL I
NSPEC:T I ) AND APF'f= O AL B'r' TH VS
C-EPARTMEN"F WILL
PE
SUBJECT TO PF:OSE:.C:I-IT I ON.
M I N I rfi R9 G' I :STAFJC:E E:E=TWE EN A WELL AND ANY ON --'I I TE SEWAGE: DISPOSAL SYS f Eh1 IS,
100 FEET FC1f? A f'(?I+HTE WELL. OF: 1`lC± TcI'iio FEETFr:CIr1 H PUBLIC HELL DEPENDING
l_IF,C J THE T'TF='E CIF PUBLIC WELL.
MINIMUM DI'SrANCE:: FF:OfT A PRIb4"ITE WELL. ro A SFHE F: EINE. IS :'_ FEET At1E,
TCI A C.ifr9M 1NITY SEWER LINE P.I. "_ FEET,
Z.
WE LL LOGS ARF (:FC!li I f:ED FiNf; PUJ`:• I' E:E: RETURNED TO THE: DF1='f IE- TMENT WITHIN C- Dr -i':
OF THF HELL_ CCiMPL.ETICIN.
O THEP REiD t I RE MENTI MAY APPLY. lPEC 1 F I CHT I ON'_S AND C CIrJ' fl -el -IC r I CIN D I AIRF-:Af S iiRE
A'•fiILABLE TO IFJ'rUFE F'F<:IjPE.F: IN'_. TALL-ATICIt1.
C = E = F:_ f 1 :C "I F_- : F 3 F F E E: ,_:" Fc_ 1' 11 E : F`=: _ -
I CERTIFY TFIf IT
a. 1 i-1 F1 F flt•1 I L- I AR WITH rHE PEOU I REMFNTS FOR ON --SITE SEWER': AND WELLS A SE: r
FCIRTH PY THE. HUN I C I PAL T TY OF' FINC:HORAGE.
_ . I WILL, I N`__•TALL THE '=,'T' TE:P1 I I1 ACCORDANCE W I Tr I THE COC.IES.
LlPJDEF. ;TFiFJC THAT 7HE:: i�IJ TEE._ S FWFR SYSTEM MAY F.EIDUIRE=: CNLARGENUNT IF THE
RE`_=IDFNC:E P-1 RENFIDELF-D TO INCL_I-IDE MCIRE= THAN 3 BEC)ROOt9S.
_R Fit IT
__r1 _lD B.._-
X SOILS LOG
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION PERCOLATION
�l 625 L. Street, Anchorage, Alaska 99501 264.4720
TEST SOILS LOG — PERCOLATION TEST
PERFORMED FOR: L� )l=ti�2A� JL DATE PERFORMED: VA-lAo
LEGAL DESCRIPTION:
DEPTH S t - -rq 5 q,jD ( SLOPE SITE PLAN
(FEET) tt Sl'.S— 0-M I I I I I I )
1
2
3
4
.^---- 5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
COMMENTS
X
TGi
rLAD E L � R
�s o
USG, - S(h/
6"=zo
WAS GROUND WATER S
ENCOUNTERED? N D L
0
P
IF YES, AT WHAT E
DEPTH?
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
'%
IS Ito
f
(minutes/inch) stF�'
FT AND FT t /�•' • •.ena..ai
AN 6
t•• R 2100 -
�'tom
�'/;n('
gr—�
Pf3 �,z'9,�0 •ani
PERFORMED BY: ,D
CERTIFIED BY: AFF, DAT $�A s
72-008 (6/79)
WATER WELL DRILLING
PUMP SALES & SERVICE
(907) 243-•7£393
KEN JOHNSON
i3 il"RT Fu
i30 J. 0--21 "x ";'
AavHORasE, 1Lii.i'% )n`i� 3P-" T)9
1 BLK 9 2'dL11 ; ,CRE'"'T ISU,B
,Li`e'f J 7r,-•
3163 LINDEN DRIVE
ANCHORAGE, ALASKA 59501
1,u t0 iJ i,o :5.1y•Ow"+i
Lot 1, Block 1
Silver Crest Sub.
Test Hole No.Z
Depth in Feet
From To
0.0' 0.5'
0.5 10.0
Date: 8/8/77
Logged By: T.L. Barber
W.O.# 10424
SOIL DESCRIPTION
Brown Peat
F-2, brown Silty Gravelly Sand, SM, many cobbles,
wet to saturated, medium density.
Bottom of Test Hole:
Frost Line:
Free Water Level:
SA.
NO. Depth Ms
1 5.0' 18.0
Remarks: 1)
2)
3)
4)
5)
6)
10.0 ft.
None observed
7.0 ft. while drilling
Type of Dry
Sample Strength Group
G L A
Unif -Led`
Classification
SM
Type of Sample, G=Grab, SP=Standard Penetration.
Dry Strength: N=None, L=Low, M=Medium, H=High.
Group refers to similar material this study only.
General Information, see Sheet 1.
Frost & Textural Classification, see Sheet 2
Unified Classification, see Sheet }.
NOTE: DRILLING REFUSAL AT 10.0 FEET.
Municipality of Anchorage ;; til3a
On -Site Water & Wastewater Program
(907)343-7904
. � 1
CERTIFICATE OF ON—SITE SYSTEMS APPROVAL
r _
Parcel I.D. 015-062-23 t ^jf f Expiration Date: f U — 1-3
1. GENERAL INFORMATION
Complete legal description SILVER CREST S/D• BLOCK 1 LOT 1
Location (site address) 9550 GROVER DRIVE, ANCHORAGE, AK, 99507
Current Property owner(s) TODD & JULIE CHURCH Day phone C/O AGENT
Mailing address 9550 GROVER DRIVE, ANCHORAGE, AK, 99507
Real Estate Agent TAM] TAYLOR W/ PRUDENTIAL Day phone 244-3504
2. TYPE OF DWELLING:
0 Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 3
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual On-site
Individual Water Storage
❑
Individual Holding tank
❑
Community Class Well
❑
Community On-site
❑
Public Water System
❑
Public Sewer
❑
Received by / Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ Oji r a -)LA 12 VS r7 Waiver Fee $
Date of Payment (a Jl, �� Date of Payment
Receipt Number oglg�-G Receipt Number
COSA# 0tL131 aha Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, t verify that my
investigation, based on procedures outlined in the Certificate of On -Site Systems 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 GARNESS ENGINEERING GROUP, Ltd.
Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK, 99507
Engineer's Printed Name JEFFREY A. GARNESS, P.E.
Engineer's Comments:
In conducting this evaluation, GEG, L1D. attempted to provide a thorough,
conscientious engineering analysis of the system in accordance with ADEC and MOA
DSD Guidelines & Regulations. The reported results described the performance of the
system under the conditions encountered at the time of the test, and separation
distances measured to readily Identsable features. The operational life of all wells and
septic systems depend on the local soils condition, groundwater levels that may
fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of the system. Satisfactory test
results do net guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. GEG, LTD. can therefore not provide
any warranty or future estimate of how long the system at continue to meet the
operational requirements of the ADEC or MOA DSD. The content of this report is for
the sole benefit of the owner listed above. Any reliance upon or use of this report by any
other person or party is not authorized, nor will it confer any legal right whatsoever.
6. DSD SIGNATURE
System #1 Approved for 3 bedrooms.
System #2 Approved for
Disapproved.
Conditional approval for
bedrooms.
Phone
337-6179
Date On )r'3
bedrooms, with the following stipulations:
ON-SITE
WATER AND
WASTEWATER
Original Certificate Date: < .1 — /3
The M6WCipali& or'An�age Deve/op,emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the represenatations given in paragraph 5 by an independent professional civil engineerregistered in the State of Alaska.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTCHMENTS:
COSA Checklist
Septic System Advisory
Well Flow Advisory
(Rev. 11105)
i
-� Nitrate Advisory
Arsenic Advisory
Other
If more than 1 septic system is on the lot:
COSA Checklist # _of_
Structure served by this system
Certificate of On -Site Systems Approval Checklist
Legal Description: SILVER CREST S/D; BLOCK 1, LOT 1 Parcel ID: 015-092-23
A. WELL DATA *PER 2008 C.O.S.A.
Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (Y/N) YES
Date completed 11/14/1980 Sanitary seal (Y/N) YES Wires properly protected (Y/N) YES
Total depth 93 ft. Cased to *93 ft. Casing height (above ground) 12+ in.
FROM WELL LOG AT INSPECTION
Date of test 11/14/1980 6/18/2013
Static water level 67 ft. 66 ft.
Well production 10 g,p,m. 3?e- 3.Se g. P.M.
WATER SAMPLE RESULTS: -� t /
Coliform Q colonies/100 ml. Nitrate T. r ;g./L. Collected by: GEG, Ltd.
Arsenic:ALP-ug./L. Date of sample: 6/17/2013
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material S.T.E.P./STEEL Date installed 5/26-27/1999
Tank size 1250 gal. Number of Compartments E Cleanouts (Y/N) YES
Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) YES
Date of pumping 6/11/2013 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE
Date installed 5/26-27/99 Soil rating OEDrftlbdrm) 0_8 System type TRENCH
Length 50 ft. Width 2 ft. Gravel below pipe 7 ft.
Total depth *11.0 ft. Eff. absorption area 700 ft2 Monitoring tube YES Depression over field NO
Date of adequacy test 6/18/2013 Results (Pass/Fail) PASS For 3 bedrooms
Fluid depth in absorption field before test 32 in. Water added 550 gal. New depth 43 in.
Elapsed Time: 130 min. Final fluid depth 40 in. Absorption rate >= 450+ g,p,d,
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE KNOWN If yes, give date
D. LIFT STATION
Date installed 5/26-27/1999
Size in gallons
1250
Manhole/Access (Y/N) YES
"Pump on" level at 42 in.
"Pump off' level at
42 in.
High water alarm level at 44 in.
Datum BOTTOM OF BASKET
Cycles tested
3
Meets alarm & circuit requirements? YES
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 100'+ On adjacent lots 100'+
Absorption field on lot 100'+ On adjacent lots 100'+
Public sewer main NSA Public sewer manhole/cleanout
Sewer /septic service line 25'+
Animal containment areas 50'+
Holding tank
Manure/animal excrete storage areas 100'+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 5'+ Property line 5'+ Absorption field 5'+
Water main N/A Water service line 10'+ Surface water 100'+
Wells on adjacent lots 100'+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 10'+ Building foundation 10'+ Water main N/A
Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+
Curtain drain NONE KNOWN Wells on adjacent lots 100'+
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that 1 have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this
date.
Engineer's Printed Name JEFFREY A. GARNESS
Date
(Rev. 11/05)
V",
CE 793
!� j2'. !�
"0ressoWlol
Municipality of Anchorage
Community Development Department
Development Services Division E,Y'
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 131292
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 1 of
Silver Crest subdivision. This inspection revealed a nitrate concentration of
7.42 milligrams per liter (mg/L) was reported for the property's well water
sample. The Environmental Protection Agency (EPA) has established a
maximum contaminant level (MCL) of 10.0 mg/L for public drinking water
systems. While private wells are not subject to this regulation, EPA
standards are based on existing health information and can therefore be used
to gauge the relative quality of water from private wells. Please see the
attached "Nitrate Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
2,1
e
UNDER NO CIRCUMSTANCES SHOULD AN AS—BUILT BE USED FOR CONSTRUCTION OR FOR ESTABLISHING BOUNDARY OR FENCE LINES.
THE SURVEYOR TAKES RESPONSIBILITY FOR THE INITIAL TRANSACTION ONLY AND ASSUMES FINANCIAL LABILITY ONLY FOR THE COST OF THE SURVEY.
USTED DISTANCES PREVAIL OVER SCALING. REPRODUCTION MAY CAUSE ERRORS IN SCALE.
Lj LOT SVRWY SURVEY TYPE WSYMBOLS
ElFWNDAnoN AS -BUILT
SET RE ASPHALT
❑ FINAL STRUCTURE AS -BUILT DRAINAGE
o FOUND REBAR 9 9 a WOOD FENCE "'' CONCRETE
❑ PLOT AS -BUILT .. ,LOtqT SURVEY . , . TOPOGRA%IY
AS -BUILT ... No caeNE w AZ RECERTIRCAIION AS -BUILT ... NO CORNERS SET ® ASSUMED ELEV. -I )E I(- METAL FENCE ® WOOD nFf.K
IT IS THE RESPONSIBILITY OF THE BUILDER OR OWNER, PRIOR TO
CONSTRUCTION, TO VERIFY PROPOSED BUILDING GRADE RELATi VE
TO FINISHED GRADE AND UTILITY CONNECTIONS AND TO DETERMINE
THE EXISTENCE OF ANY EASEMENTS, COVENANTS OR RESTRICTIONS
WHICH DO NOT APPEAR ON THE RECORDED SUBDIVISION PLAT.
SURVEY CERTIFICATION
PLOT PLAN
•71-
••
•.
ANY agNlY qR I Kw MYIdl1 Y.MI•E
W KK Im m0 CmO.E M•m. qM
.•/`P.•••••
••.�I
e.0
fan IaM m.NW4AM tll M q. N! w�nw•
�;.'
lu'•�m�••Iwlw : e�AV}�
t
.yep. �I'tlal
qY
•.�
mwM mE edrot
t
•...
FOUNDATION AS -BUILT
'•• •• • .:,.
n....
I, A. E YM•. Jr- Y , -V, that I
Ym. aAma•1 mAt-BY! y M 1Ne
farWYm m qY KK m! qrt iM•
.......•.• •...
• •.•.••
agm.lm. me Ylmnaum m � I�...�
`•••••� R
o• Oua atl ro mvmNnmLL e1•t uWi
`�� 41 ��
`
_S •AgA1
FINAL STRUCTURE AS -BUILT
s•�
•1.••
.'
4 RMi E .Wn•, b.. M•CY .meY ed I
Mw pYlanMU m Al-B•�Ll YNy Of fM
Pp
`.•�
� :` pl �
" `
.w•wa m qd KK ma tha, a q.
a
•�I, pyo
•
IAn• me Yrggaom m q•vn nmaa
bw me rle mpmtlmmb qM wr
.._ (essional•L°^.••1
ONLY THOSE IMPROVEMENTS ABOVE GROUND AND VISIBLE WILL BE
SHOWN. FENCES. WELLS, SEPTIC CLEANOUTS, SIDEWALKS. DRIVEWAYS,
ETC., ARE SHOWN IN THEIR APPROXIMATE LOCATION, ONLY. SNOW
MAY PREVENT SOME IMPROVEMENTS FROM BEING SEEN AND LOCATED,
ALL DISTANCES ARE RECORD UNLESS OTHERWISE NOTED.
Prepared by
Robert E. Johns, Jr. & Assoc.
Professional Land Surveyors
1700 Brink Drive.
ANCHORAGE, ALASKA 99504
:ole: 1„ C 601 Rea Lot S.F. Rec. Plot File No.
06/22/13 °,FMK
06/24/13 Gr1: 2439 WD 13-279
Lot 1 BLOCK 1
SILVER CREST
Municipality of Anchorage
• Development Services Department
Building Safety Division ;
On -Site Water and Wastewater Program '
4700 Elmore Road
P.O. Box 196650
Anchorage, AK 99507
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015.062.23 COSA # MD35O
Expiration Date: 1 t% d
1. GENERAL INFORMATION
Complete legal description Lot 1, Block 1, silver crest Subdivision
Location(skeaddress) 95500roverDdve Anchorage. AK 99516
Current Property owner(s) Katharine and Eric Fontaine Day phone
Mailing address 9550 Grover Drive Anchorage, AK 99516
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. -NUMBER OF BEDROOMS: Three (3)
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well 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 On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of On -Site Systems 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 COSAs upon request to homeowners. Certificates of Onsite Systems 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 afrLxed hereto and as of the validation date shown below. I verify that my Investigation,
based on procedures outlined in the Certificate of On -Site Systems 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 Anderson Engineering
Address P.O. Box 240773 Anchorage, AK 99524
Engineer's Printed Name Michael E. Anderson, P.E.
Phone 522-7M
Date tormoos
ae . MICHAEL E ANDERSON
AW
,pi'• CE -4381
S. DSD SIGNATURE �eJi�Q.�p �p6 `rcy
Approved for bedrooms. i1/awp..�V%s�'
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist X Arsenic Advisory
Septic System Advisory. Maintenance Agreements
Well Flow Advisory Supplemental Engineer's Report
Nitra a Advisory k/ Other
E83 Original Certificate Date:
(R.. nns)
Municipality of Anchorage
Development Services Department
Building Safety Division ,
On -Site Water & Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995196650
www.muni.org/onsfte
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 1, Block 1, Silver Crest Subdivision Parcel ID: 015-062.23
A. WELL DATA
Well type Private If A. B, or C provide PWSID #_ Well Log (Y/N) Y
Date completed 11/14/80 Sanitary seal (Y/N) Y
Total depth 93 ft Cased to 93 ft.
FROM WELL LOG
Date of test 11/14/80
Static water level 67 R
Well production 10 9 P.M.
WATER SAMPLE RESULTS:
Coliform 0 colonies/100 mL Nitrate 6.54 mg/L
Arsenic: N!D mgA Date of sample: 9/8108
B. SEPTIC/HOLDING TANK DATA
Wires properly protected (Y/N) Y
Casing height (above ground) >18 in.
AT INSPECTION
9117ma
74 ft.
4.1 g.p.m.
Otherbacteda 0 colonies/100mL
Collected by: J. Davis
Tank Type/Material STEP/Steel
Date installed sa6/9e
Tank size 1.250 gal. Number of Compartments Three Cleanouts (Y/N) Y
Foundation cleanout (YM) Y Depression over tank (Y/N) N High water alarm (YM) Y
Date of pumping 9/22/08 Pumper A Plus Home Services
C. ABSORPTION FIELD DATA
Date installed =9199 Soil rating (g.p.d./ft2 orft2/bdrn) !GPD/SF
System type Deep Trench
Length 50 ft. Width 2 ft. Gravel below pipe 7 ft.
Total depth LILI1 ft Eff. absorption area 700 ft Monitoring tube Y Depression over field N
Date of adequacy test 9/17108 Results (Pass/Fail) Pass For 3 bedrooms
Fluid depth In absorption field before test 68.5 in. Water added 531 gal. New depth 83 In.
Elapsed Time: 1.350 min. Final fluid depth 68.5 (n. Absorption rate >= 450
g.p.d.
Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
Date InstaIIed__!2W_9 Size in gallons 250
Manhole/Access (YIN) Y
'Pump on' level at 42 in. 'Pump off" level at 42
in. High water alarm level at in.
Datum Bottom of Tank Cycles tested Five (5)
Meets alarm & circuit requirements? Y
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot >100'
On adjacent lots >100'
Absorption field on lot >100'
On adjacent lots >100'
Public sewer main N/A
Public sewer manhole/cleanout NIA
Sewer/septic service line >25'
Holding tank NIA
Animal containment areas None
Manure/animal excrete storage areas None
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5' Property line>S
Absorption field >5'
Water main NSA Water service line
>10' Surface water >100'
Wells on adjacent lots >100•
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10
Water Service line >10' Surface water >100!
Driveway, parking/vehicle storage >25
Curtain drain None Noted Wells on adjacent lots
>100'
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 COSA guidelines In effect on this date.
Engineer's Printed Name Michael E. Anderson, P.E.
Date 10/3!2008
COSA Fee $ Waiver Fee $ _
Date of Payment Date of Payment
Receipt Number Receipt Number
(Rev. 11/05)
4918,0
CE='4381 .-4
4�Ia:RdfESS10H��«
-� Municipality of Anchorage
Development Services Department
i Building Safety Division '
- On -Site Water and Wastewater Program '
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsitc
(907) 343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 080352
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot 1 of
Silver Crest subdivision. This inspection revealed a nitrate concentration of
6.54 milligrams per liter (mg/L) for the property's well water sample. The
Environmental Protection Agency (EPA) has established a maximum
contaminant level (MCL) of 10.0 mg/L for public drinking water systems.
While private wells are not subject to this regulation, EPA standards are
based on existing health information and can therefore be used to gauge the
relative quality of water from private wells. Please see the attached "Nitrate
Fact Sheet" for important information regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
1 _ •',IION? It!
�F !4
♦
♦
•X-ROME-SERVICES;''INC.
7501 F .140th Avenue
Anchorage, Alaska 99516
345-1890
CUSTOMER
Frio Foataine
955 a%w Street
Blade Lot
� 1
Page 1 of 1
INVOICE# 35
DATE DESCRIPTION
A
09-22 'a Pump Septic 8
lean Staticn t
,,,' ��i t•: 3 f 6
rr • 1 .AI
w7 ;.., i.. d L i .. P x. i '5,:: o '-
C`;� " I
344-6815
IZ071300gallons,2st=4ipes,4hosietI
orate m behmdhouse k f ( f
'?
TOTAL,
C
1 I I IRENARK$
_1_ f Li-vl..t ./ / �� v'/„ � ✓ is o�:'�,.--%..�!_ _.. �'-. � b/'ty /._ �_ 1 /
%:1-i�) Gallons � Septic Leach Area Holding Tank Standpipes 422-
❑ -,PROBLEM AREA—CALL FOR MORE INFORMATION
❑ NEEDSTO BE DONE AGAIN IN 6 MONTHS
D ' Good Shape ❑ sludge buildup on bottom ❑ Floater on top
❑ Jim cap missing or ❑ Cut standpipe to 1' above ground ❑ Needs Septictrir
needs replacing
https://mailstore-l.gci.net/attachl2008_ScpticService jpg?sid=wQgM7+35NvY&mbox=IN... 9/22/2008
SGS ReLN
1084784001
Client Name
Anderson Engineering
Project Nlme/N
LI,B 1 Silver Crest
Printed Date/Time
Client Sample ID
9550 Grover
Collected Date lflme
pLMz
Drinking Water
Received
Received Dade fine
Director
P9VSM
0
Sample Remarks:
Pmametcr
Results PQL
Metals by ICP/MS
Arsenic
ND 5.00
Waters Department
Total Nitrate/Nitrite-N
6.54 0.100
09232008 14:13
09/082008 13:47
09/082008 14:40
Stephen C. Ede
Allowable Prep Analysis
Units Method ContvnerlD Limits Date Date Init
ug/L EP200.8 C (<10) 09/15/08 0922/08 NRB
mg/L SM20 4500NO3-F B (<10)
Microbiology Laboratory
Colony Count 0 cotIl00mL SM20 9222B
Total Coliform 0 coV100mL SM20 9222E
Fecal Colifonn 0 cOV100mL SM20 92228
A (<200)
A (<I)
A (<I)
09/15/08 2DZ
09/08/08 DLC
09/08/08 DLC
09/08/08 DLC
SGS ENVIRONMENTAL SERVICES
Chain of Custody for Total Coliform Bacteria Samples
READ NSTRUCTIONS ON REVERSE SIDE BEFORE COLLECTM SAMPLE
MUST BE COMPLETED BY WATER SUPPLIER
❑PIRIM WATER SYSTEM Im
IDPWATE WATER SYSTEM t,,
)] Send Results C� SSM ervolce
wmr Slsrem N��' Nene Canact Nrro
Pts-, N Pre NI Pa.
P � 3
OL,
sW
fie.
q iiq
SAMPLE COLLECTION:
200 W. POTTER DRIVE
ANCHORAGE -'ALASKA 99518
Tat 907-602-2313
Fax:907-6814301
1084784 1A
❑ Send Results ❑ Send Imoice
SAMPLE TYPE:
NOTE, For varid results, analysis must begin within 30 hrs of sample collection.
Date: ®a
❑ Membrane Filtration
. t7g
❑ Presence/Absence
Month
Time: : 141
Location: t.OT t
Day
Year
rs.�I
AM u•m drde one)
Routine ❑ Treated Water
%SSV `'sr0Y�❑ Repeat Sample ® Untreated Water
91oc L
Collector. � S
Ported LI I ?LA ,,m'
��
(refer to tab no. 1
❑ Special Purpose
Signature
Transported
to Lab By: J$ Same as collector
Other.
Printed Name Signature
Note: SGS analyzes bacteria Samples in ADECs 30 hour hold time unless prior arrangements have been made.
Surcharges Wlg be applied for samples received Q hours before expiration.
Business hours are Monday -Friday. 8 am -5 pm. Please contact your Project Manager at (907) 562-2343 with any questions.
TO BE COMPLETED BY LABORATORY .
Sample Receiving: 9,/?,/C.
L� ❑
Date: 7 C.
Tana. /�/�i0 ❑
Temp:
Delivery Method: ❑
Received By. I'
Oonm.m: Printed Name
Sample over 30 hours old. Results may be unreliable.
48 Hour Weiverfor Remote Locations
not,red Anatyst of Short Hold Time
This section used by analyst for Immediate notification of UNSATISFACTORY results ony:
Result:
Reported to:
Reported to:
Anaysfa
Signature:
By.
By.
Date/rime:
❑ Fax ❑ Phone ❑ E-mail
❑ Fax ❑ Phone ❑ E-mail
Form 0 FW -0053 revised 0a21W
7
D
n
D
D
n
I
PLOT PLAN _ AS BUILT _ SCALE IL- 50GRIDNW 1361 Project No,05=094
Lan &Associates II1C. 11500 Daryl Avenue, Anchorage, Alaska 99515-3049
Lang (907) 522-6476 Phone c�pAQp
Registered Land Surveyors (907) 522-4625 Fax o4�QrCA Op
kglangisOalasko.net / jclanglsOolasko.net �.``.............. �
I hereby certify that I have surveyed the following described property. O�'`Q
Lot B. EATON PARK SUBDIVISION '
;? 49
Anchorage Recording District. Alaska, and that the Improvements situated thereon are ••• ••••••
within the property lines and do not encroach onto the property adjacent thereto, that
no Improvements on the property lying adjacent thereto encroach on the surveyed „ .... •
promises and that then are no roadways, transmission lines or other visible KENNETH G.
easements on said property except as Indicated hereon. p, —202
Dated this the I��ef Sts PtCinP�wcL^r S��"^�w2 Zoog _ at Anchorage. Alaska "UUUU 1 .01� -
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.
*z
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel L.D.# 0I3— —cZ ,
1. GENERAL INFORMATION
Complete legal description Lo7 t, 13 K l f S I LVA>Z CRFs I
Location (site address or directions) cf 5 5 (D G r2 v l/ L r2 0 i2
Property owner (al-)L4rCA.4 Day phone
Mailing address ��I rvl.� e
Lending agency ��� s d a �or�4gue4_ AOLYO-,J:�'1.dtDay phone
Mailing address
Agent `�xYr� i S 4Ya� 9 �2' to c Day phone
Address
Unless otherwise requested, HAA will be held for pickup
2. NUMBER OF BEDROOMS:. 3'4
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
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
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 N21
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 I orb e Phone
Address off° 3 I LG, -kl 2- 3
Engineer's signature Date
6. DHHS SIGNATURE
Approved for TH(f EF bedrooms.
Disapproved.
Conditional approval for bedrooms, with the following stipulations:
Th /i u4 Go P-, ; .*lira /Q✓Jk,) Poon_ !tee /erscS
Gon it0' � e.;2/0v0y4-l ate` Ll -19 -q-'
Additional Comments
0
4l1TIC
Date G -'), /-'clq
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(Rw. 1/91) Back MOA X21
Municipality of Anchorage I C c 1 61V1
YA
DEPARTMENT OF HEALTH & HUMAN SERVICES
Environmental Services Division JUN 1999
825 L Street, Room 502 • Anchorage, Alaska 99501 • (90W343Tpa74y cf Anchorage
Dept. Health & Human Services
Health Authority Approval Checklist
Legal Description: LD 1 V.,1 S i (,I -e -v- CV' -e-s �- Parcel I.D.: O - D h 7---
A. WELL DATA
I'q
Well type If A, B, or C, attach ADEC letter. ADEjC water system number
(
Log present (Y/N) _ / Date completed 12-1,8o
1
Total depth Cased to `a3 Casing height (above ground)
Sanitary seal (Y/N)
Date of test
Static water level
Well production
/ FROM WELL LOG
Irgf go
0
g. p. m.
Wires properly protected (Y/N)�—
AT INSPECTION
3/-7Isy
9
L -r
9—
p.m-
WATER SAMPLE RESULTS: %
Coliform Vi Nitrate kill 61L Other bacteria
Date of sample:�L< i Collected by:
B. SEPTICA40=114G"TANK DATA
Date installed �;2 Y`t Tank size /A 0 Number of Compartments o�- Cleanouts (Y/N)---X_
Foundation cleanout (Y/N) Depressionn((Y/N) High water alarm (Y/N)
Date of Pumping N-u� Pumper v
C. ABSORPTION FIELD DATA
b
Date installed 2G �__ Soil rating (g.p.d./ft2 or ft2/bdrm) (9 F System type t c_
Length -to Width 6'- Gravel thickness below pipe 7 Total depth
Effective absorption area -10'0 Monitoring Tube present (Y/N)--�- Depression over field (Y/N)
Date of adequacy test _hj.-unite Results (Pass/Fail) 7 For bedrooms
Fluid depth in absorption field before test (in.); immediately aftergal. water added (in.): ✓
Fluid depth '/ (ins) Minutes later: /Absorption rate = g.p.d.
Peroxide treatment (past 12 months) (YM) If yes, give date
72-026 (Rev. 3/96)*
D. LIFT STATION
Date installed Size in gallons
Manhole/Access (Y/N) V "Pump on" level at* y/ /2- 'Pump off" level at* V2
High water alarm level at* q`( *Datum 0
Cycles tested �Z f
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot % o Z On adjacent lots > /0(
Absorption field on lot I 6,C) On adjacent lots
Public sewer main
N/A,
Public sewer manhole/cleanout
N�
Sewer /septic service line
(q t]
Lift station
10 :•-
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO:
Foundation c2 7 Property line �2 �5 Absorption field S-5
Water main/service line i,;25 Surface water/drainage tAJ-D Wells on adjacent lots 1 t °-C)
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 4D Building foundation %D Water main/service line *> iv -o
Surface water N 10 V1 e-- Driveway, parking/vehicle storage area I aL2
Curtain drain I_l 0 K 102 Wells on adjacent lots > 10-0
F. ENGINEER'S CERTIFICATION
I certify that I have determined thru field inspections and review of Municipal records fhat the-abbve.systems are
in conformance with MOA HAA guidelines in effect on this date.
Signature
Engineer's Name 1 0 1, P V V,
Date
w
r..
HAA Fee $ p Waiver Fee $ _
Date of Payment ., Yo Date of Payment
Receipt Number + Receipt Number
72-026 (Rev. 3/96)*
T.SPURKLAND P.E.
203 W. 15th. AVE. SUITE 203
ANCHORAGE, ALASKA 99501
(907) 279-3916
Fax (907)-276-6013
Municipality of Anchorage
Department of Health and Social Services
825 L Street
Anchorage, Alaska 99501
Subject: Conditional HAA
Silver Crest Block 1, Lot 1
PID 015-062-23
Gentlemen;
June 10, 1999
RECEIVED
JUN '16 1999
Municipality of Anchorage
Dept. Health & Human Services
The septic system has been upgraded on this property in accordance with the attached As Built.
Please issue an unconditional HAA.
Yours
7SpSurrand P.E.
MUNICIPALITY OF ANCHORAGE
• DEPARTMENT OF HEALTH & HUMAN SERVICES
Division of Environmental Services
On -Site Services Section
P.O. Box 196650 Anchorage, Alaska 99519-6650'
343-4744
CERTIFICATE OF HEALTH AUTHORITY
APPROVAL FOR A SINGLE FAMILY DWELLING
Parcel l.D. # Ol 061— 9 HAA # 'C -\S'1 L 1 1
1. GENERAL INFORMATION
Complete legal description A U i ! 3V� 1, �; (✓ ✓ ce e s�
Location (site address or directions) D C7 y -,v ✓� ✓ >
Property owner P'k-' Ll"e ('-xlet,rAr Day phone
Mailing address 1rn ✓e
Lending agency Day phone
Mailing address
Agent 13f <- � J r�w�� 2 ��' i� Day phone 7G /
Address L O -e,) iii fN
Unless otherwise requested, HAA will be held for pickup.
2. NUMBER OF BEDROOMS: 3
3. TYPE OF WATER SUPPLY:
Individual well
Community well
Public water
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
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 N21
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.
Name of Firm 1 b 6e nu V_ld � L Phone
Address
�_o 5 Le, 1.3- " H Z -o
Engineer's signature
A- 4
- Date - VA j
L,Y tj a�t1 ,1
p /1 L-
6,4 _6,4 ` 1
6. DHHS SIGNATURE
By:
CA_t�(
Approved for bedrooms.
Disapproved.
__X__ Conditional approval for R bedrooms, with the following stipulations:,
Money shall be put in escrow in the amount of 1.5 times the high bid of three(3)
bids from—excavators rPYtJfiaA liy this affire fnr the ronatrnrtinn of the
proposed wastewater system pursuant to Permit # SW990041 attached. Money in
escrow shall net bereleased tint!! this effiee has given final approval.
Construction of this system shall be completed by no later than June 15, 1999
Additional Comments
411Th
Date
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) Back MOA #21
' itt TOD
a ^il
ed
C-
S
__X__ Conditional approval for R bedrooms, with the following stipulations:,
Money shall be put in escrow in the amount of 1.5 times the high bid of three(3)
bids from—excavators rPYtJfiaA liy this affire fnr the ronatrnrtinn of the
proposed wastewater system pursuant to Permit # SW990041 attached. Money in
escrow shall net bereleased tint!! this effiee has given final approval.
Construction of this system shall be completed by no later than June 15, 1999
Additional Comments
411Th
Date
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) Back MOA #21
RECEIVED
Municipality of Anchorage APR 14 199
DEPARTMENT OF HEALTH & HUMAN SERVICESMUNICIPALITYOFANC
Environmental Services Division ENVIRONMENTALSERVIC
825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744
Health Authority Approval Checklist
Legal Description: LP. 80, ':) L I yev � Parcel I.D.: Ill " 6) &:L- 13
A. WELL DATA
Well type iz If A, B, or C, attach ADEC letter. ADEC water system number N/h-
Log present (Y/N)
Date completed "I 14 (�N 0
Total depth 9.3 " Cased to I 3 Casing height (above ground)
Sanitary seal (Y/N)
FROM WELL LOG
Date of test
Static water level
Well production
WATER SAMPLE RESULTS:
Coliform .-&-
Wires properly protected (Y/N)
AT INSPECTION
�l % cl `i
b c' 1
..-
Nitrate 4 V4eS/ f Other bacteria W -D
Date of sample: N/1)-/ rj t; Collected by:
B. SEPTIC/HOLDING TANK DATA
Date installed 10 -IS- Ir Tank size ) ;2 d; b Number of Compartments 1 Cleanouts (Y/N)--Y—
Foundation cleanout (Y/N) _4_ Depression (Y/N)
Date of Pumping `�` �" h Pumper
z� a,t-t of annc_!.f'
1l7 High water alarm (Y/N)
C. ABSORPTION FIELD DATA
iv - a& - 7•i
Date installed '7 - u - 3A- Soil rating (g.p.d./ft' or ft2/bdrm) 168 System type IAA-+aC
Length 74 t 2 5 Width 1,21 Gravel thickness below pipe H � Total depth 1„2 �
Effective absorption area 54- V � I L f'. Monitoring Tube present (Y/N)r_�/_ Depression over field (Y/N) t-)_
Date of adequacy testResults (Pass/Fail) ! For bedrooms
Fluid depth in absorption field before test (in.); _Alij' _Immediately afters gal. water added (in.):
Fluid depth (ins) Minutes later: ✓ Absorption rate g.p.d.
Peroxide treatment (past 12 months) (Y/N) ✓ If yes, give date
72-026 (Rev. 3/96)* .7 I lol J a t't k�
D. LIFT STATION
Z /1
Date installed
Manhole/Access (Y/N)
High water alarm level at' _
Cycles tested
E. SEPARATION DISTANCES
Size in gallons
"Pump on" level at'
'Datum
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic/holding tank on lot
Absorption field on lot
"Pump off" level at`
On adjacent lots > I v
On adjacent lots > i t-C�
Public sewer main rl�!} Public sewer manhole/cleanout _,
Sewer /septic service line i Lift station 1-4/
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
I-A�i
Foundation O?V Property line '? U � Absorption field 1 y �
Water main/service line _Surface water/drainage 1t t L Wells on adjacent lots i i v O
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line aU Building foundation 'YO Water main/service line I V-0
Surface water _ I� Driveway, parking/vehicle storage area 6-0
Curtain drain rl
Wells on adjacent lots 5 /u-0
F. ENGINEER'S CERTIFICATION =~
1 certify that I have determined thru field inspections and review of Municipal regorde 6aah6 0ovi. systgms are
in conformance with MOA HAA guidelines in effect on this date.
c ,
Signature
Engineer's Name 1 0 42 -e i.r 12v ✓ Za
Date
HAA Fee $ 3 6 ti -a7)
Date of Payment h/%C
Receipt Number /V 7 7� �•Z?
72-026 (Rev. 3/96)"`
Waiver Fee $
Date of Payment
Receipt Number
MONICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE
1. General Information Application Date Z /' I j 6'.
(a) Legal Description (include lot, block, subdivision, rection, township, range)
-7
Location (address or directions)
(b) Applicants NamcTelephone Home Business
Applicants Address
/J
(c) Applicant is (check one) Lending Institution t5�rner AgAder
F".-
Buyer 00
Other (explain);
(d) Lending Institution T eLe�phq.IL(j
Address %j kit,- K&Y"
(e) Real Estate Co. & Agent
-1 ej
Address J'A
—A V�'
Telephone
(f) Mail the HAA to the following address.
2. Type of Residence
Single --Family Multi -Family OtherdeRqrba).
Number of Bedrooms
Water
Individual Well Commtrait-y Public
Notes if community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Seunge Disposal
Onsite.
Public Community Holding Tank El
Note: 1� community well system, must have written confirmation from the State
Department of Environmental Conservation attesting to the legality and status.
[Page 1 of 2]
S. Irn !.Deering 1?iter Prov�:.cl3,n Ins actions, 'iesLs ]?ileSearch Data and Information
As certified by my seal affixed hereto and as of the validation date shown be -low, I
verify that my tnvestigation of this Health Authority Approval shows that the oa�stie
crater supply and/or o,mstewater disposal system is safe, functionnl and adegw-ite 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 f-rora my
investigation. and inspection, the ow-oite crater supply and/or wastewater disposal
system is ira compliance- crlth :all Municipal and State codes, ordinances, and regula-
tions in effect on the date of this inspection.
Name of Firm >� . �'elephone�_- {
Address
L
Date �/ /_ fi �� s — -��. 7T• eeeO c e ep °oe;E4 .�ej
f' c -
(F 'LNEER SF4h)ZOO e� s�] nue ccn/� a �oe/pJ�j fi
p� Y JS n
6. IJHEX ADT)rova7 r�
Approved for.//,,..I . -- bedrooms By
Approved / Disapproved ��W.. Conditionals
Terms of Conditional. Approval
CAUTION
THE MUNICIPALITY OF ANCHORAGE DEPAR'z INT OF MALTH AND EN IROLHEIMtet. PROTECTION
(DREP) ISSUES HCALTH AUTHORITY iWPROVAI. GERTIFICAT'F,S BASED S'OLELv UPON BE MP RESEI'711-
ATIONS GIVEN IN PAMAGIUM 5 ABOVE BY AN INDEPENDENT PROF) SSION&L ENG1*4171ER REGISTEIMW
IN THE; STAFF OP A7,ASK&. THE DTHEP DOLS THIS AS A COURTESY TO s^liLl;IMSERS OF FLOMES AND
THEIR LENDING INSTIzIT?°IONS IN ORDER TO SATISFY CERTAIN Z:EDEUL MID STAT -E REQUIRE-
MENTS. EMPLOYEES OF IMEP DO NOT CONDUCT INSPECTIONS OR ANAL%2E LL4f4 BEFORF A
CERTIFICATE IS ISSUED. THE MUNICIPA1,ITY OF ANCHOR.A.GE IS NOT RESPONSIBLE FOR. ERRORS
OR 014ISSI'ONS IN THE PROFESSIOW. ENGINEER'S WORK.
RR.4/ej/DI.3
(DHEP SEAL)
7-19-84[Page 2 of 2]
MUNICIPALITY OF ANCHORAGE
DEPT. OF HEALTH 8,
MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION
HEALTH AUTHORITY APPROVAL (HAA)
CHECKLIST- FEBRUARY 1984 ' 2 '
264-4720 �` `, L
Legal Description: 1-6' /����� `� /EIV a -
/_/JAS o7 z`7
A. WELL DATA
Well Classification /� L'� If A, B, C. D.E.C. Approved (Y/N)
Well Log Present Y/ ) Date Completed �1 / 4 5 Yield q+A''�
Total Depth `/ / Cased to e UI3 �� Depth of Grouting
Static Water Level lQ '?" L? Pump Set At
ii
Sanitary Seal on Casin (VN)
Depression Around Wellhead (Y6)
Casing Height Above Ground —
Electrical Wiring in ConduicON)
Separation Distances from Well:
To Septic/Holding Tank on Lot 10 On Adjoining Lots
To Nearest Edge of Absorption Field on Lot ��` / ; On Adjoining Lots �Dy
To Nearest Public Sewer Line
Cleanout/Manhole
Water Sample Collected by
Water Sample Test Results _
Comments6t�QG�}b✓thy)`
B. SEPTIC/HOLDING TANK DATA
— To Nearest Public Sewer
To Nearest Sewer Service Line on Lot
i
Date
Date Installed D /it Size No. of Compartments Z
Standpipes l) Air -tight CapsePN) Foundation Cleanout (Y/X)
Depression over Tank (Y N) Date Last Pumped Z
Pumping/Maintenance Contract on File (Y/N) — ; for
Holding Tank High -Water Alarm (Y/ N) Temporary Holding Tank Permit (Y/N)_—
Separation Distances from Septic/Holding Tank:
To Water -Supply Well /0
To Property Line f 3D k
To Water Main/Service Line f 04
Course
Comments
Page 1 of 2
72-026(11/84)
To Building Foundation P 4�
To Disposal Field /
To Stream, Pond, Lake, or Major Drainage
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata Type of System Design
Date Installed /d `1 Length of Field /
Width of Field ' Depth of Field /
p Gravel Bed Thickness i
Square Feet of Absorption Area _ �( Standpipes Presen (Y%N)
Depression over Field (Yeg Date of Last Adequacy Test _
Results of Last Adequacy Test C�421 4-- % #
Separation Distance from Absorption Field:
To Water -Supply Well iii To Property Line J- 019 /�
To Building Foundation To Existing or Abandoned System on
i
Lot /✓ On Adjoining Lots
To Water Main/Service Line/O To Cutbank (if present)
To Stream/Pond/Lake/or Major Drainage Course I- /D(c D
To Driveway, Parking Area, or Vehicle Storage Area a � ✓ � vl
Comments flu-
D.
tiu
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Comments
an
Dimensions
�s (Y/N)
pOff,Level-at '
— Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I ave checke , verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Signed I Date mfg_J^OF A4
Company /q 2 ` �✓(L MOA Noc ..•.•
P Y ` -- . `.�T`6._; `��-- a '� .. •e
Aye•• °o��
Receipt No. J� �l -a 0*10
Date of Payment a 18.� J06860069 a • aaaoveus S
S
Amount: $ Ll 185-
®it4fie�rKJ
$e c ;� ler C. Reid, Jr
.o. 2251-' .e .c,
?ROfcSSt�t,�_`,
Page 2 of 2
72-828 (11/84)
5. LEGAL DESCRIPTION /
DR:TE RECEIVED
INSPECTION
APPOINTMENTS
TIME
TIME
TIME
DATE
❑ One ❑ Four El Other
DATE
DATE
❑ MULTIPLE FAMILY
DZ Three ❑ Six
7. WATER SUPPLY
1. —
INSPECTOR
* ATTACH WELL LOG. A well log is required for all wells drilled
INSPECTOR
INSPECTOR
❑ PUBLIC UTILITY
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
MUNICI CHORAGE
to INDIVIDUAL/ON-SITE**
DCPf. OF F,FAL(H &
❑ PUBLIC UTILITY
MUNICIPALITY OF ANCHORAGE ENViROIvMEN1'AL PEOJECTION
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
625 L Street - Anchorage, Alaska 99501
81
UR{
ENVIRONMENTAL SANITATION DIVISION
Telephone 264.4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing.
1. P. PERTYO_WNER
y
PHONE
MA LING ADDRESS
u
j21) J�62X
PROPERTY RESIDENT If different from above) PHONE
2. BUYER
PHONE
MAILING ADDRESS
3. LENDING INSTITUTION
PHONE
s -
MAILING ADDRESS
O
7
4. REALTOR/AGENT
PHONE
*
M LING ADDRESS
5. LEGAL DESCRIPTION /
47-1
C
STREET OCATIO
6. TYPE OF RESIDENCE
NUMBER OF,BEDROOMS
❑ One ❑ Four El Other
SINGLE FAMILY
❑ Two ❑ Five
❑ MULTIPLE FAMILY
DZ Three ❑ Six
7. WATER SUPPLY
P4 INDIVIDUAL*
* ATTACH WELL LOG. A well log is required for all wells drilled
❑ COMMUNITY
since June 1975. For wells drilled prior to that date, give well
❑ PUBLIC UTILITY
depth (attach log if available.)
S. SEWAGE DISPOSAL SYSTEM
to INDIVIDUAL/ON-SITE**
f yo YEAR ON-SITE SYSTEM WAS INSTALLED.
❑ PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79)
72-010 (Rev. 6/79)
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
❑ SINGLE FAMILY
❑ MULTIPLE FAMILY
NUMBER OF BEDROOMS
❑ ONE
❑ TWO
❑ THREE ❑ FIVE ❑ OTHER
❑ FOUR ❑ SIX
2. WATER SUPPLY
❑ INDIVIDUAL
❑ COMMUNITY
❑ PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DEPTH OF WELL
DATE DRILLED
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
❑INDIVIDUAL/ON -SITE
❑PUBLIC UTILITY
Connection Verified
PERMIT NUMBER
DATE INSTALLED
Q —�
INSTALLER
❑Septic Tank or ❑ Holding Tank
Size: I D-Yv If Tank is homemade
give dimensions:
SOILS RATING
TYPE OF TANK
MANUFACTURER
TOTAL ABSORPTION AREA
MATERIAL
4. DISTANCES
WELL T0:
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
Absorption Area to nearest Lot Line
5. COMMENTS
[APPROVED FOR BEDROOMS
❑ CONDITIONAL APPROVAL (letter must accompany certificate)
❑ DISAPPROVED
DATE Q
Q,
BY p
72-010 (Rev. 6/79)
14
;, I.A81-1
Roberi A. Pol-(- "I , (lan
jn)sn (AMcc, Box 10-2177
Anchmage, Waska ') 1) 5,]_.i.
LI - I l- fl
j9j)a 0
1 1 i � � t
AWSKA 99501-1 LOLD
'al sower an,3 wat(--c faci.11-ILies
ApprC.)-va; 1-0:LY01,117 QW.A(WE
cannol, !)i- lmt�.A. the fo'l-lowing itenl� have heell
comp'l e-Lud :
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Rucilholl z j R.S.
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L
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L iA 13 /1 j%
cc? Maska SUMAnank
310 w Nortliern Ri(ghtin Boulestaral
995023
needis
to be.
delivered
to
offl_cc' torn thischem-,,a-b,
-
5633
B S Lx.
ee L,
f o'. 0 1 A .1-,-C-,v imv
(2) Exposecl, elec:Lri-cal %vjre5, LO the
we'll
head are
-in
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V 7.0 a.a i -1 1C -i -})iia].. o
f Anch
r l g e
L
d �S
co c
alld CC)lldLlD--
711 j- s
vn'- 11,
need
,,o !.)e by this office.
ii ;:here are any fajft-h(-:r (JUe5L-1011,
C 111.
th i S
c, f i- c -c- :-t -.6•h-x'77.0.
s, 1n c (2 ru .1 Y ,
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!:,- I `f i r of 1111 e n tom. 1. S p c-, c is 1 -.1St:
L
1 ist-
L iA 13 /1 j%
cc? Maska SUMAnank
310 w Nortliern Ri(ghtin Boulestaral
995023
50345
ALASKA eliuffinWTAL conTnoL SehiUS, IN.
lengineering & Environmental studies �� Z• � G -�
ROBINSON
9550 GROVER DRIVE
ANCHORAGE ALASKA
99507
SELLER—SAME
LEGAL -SILVER CREST BLOCK 1 LOT 1
ADEQUACY TEST FOR SEWER SYSTEM
ADEQUACY TEST DATE—JUNE 28 1985
ROBINSON
9550 GROVER DRIVE
ANCHORAGE ALASKA
99507
THE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN—UNiKNOWN AREA:
THE SYSTEM IS CAPABLE OF ACCEPTING 360 GALLONS OF WATER PER DAY.
THE SURGE CAPACITY OF THE SYSTEM IS 282 GALLONS.
BASED UPON THE TEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A
HOME OF 3 BEDROOMS.
SEPTIC TANK ADEQUACY
THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR
THIS 3 BEDROOM HOUSE.
THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON JUNE 28 1985 .
FLOW TEST ON WELL,
WELL FLOW DATE—JUNE 2.8 1985
THE WELL FLOW RATE WAS 3.9 GPM FOR 2 HOURS.
THE WELL IS ADEQUATE FOR THIS 3 BEDROOM HOME.
�.
Ov Af,
a�ie+ n<au :c uao G"e �y �f
1200 Ulest 33rd Auenue. Suite � • Anchoroge, Alasko 99503 • (907) 561-5040
JULY 3 1985