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HomeMy WebLinkAboutSKYLINE VIEW #1 BLK 3 LT 2Skyline View #1 Block 3 Lot 2 #051- 191- 30 Municipality of Anchorage gF , Development Services Department Building Safety Division On -Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 2 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: OSP111224 PID Number: 051.191-30 Name: Mary Jane HadenAddress: Wastewater System: El New Upgrade 23023 Elder Drive ABSORPTION FIELD Phone: Number of Bedrooms: ❑ Deep Trench D Shallow Trench ❑ Bed l7 Mound 0 Other: LEGAL DESCRIPTION Soil Rating: Total Depth from original grade: GPD/Ft?Ft. Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe: 3 2 SkylineViewilill FL Ft. Township: Range: Section: Fill added above original grade: Gravel Length: Ft. Ft. Well: ❑ New ❑ Upgrade Gravel width: Number of linea: I Distance between lines. Ft. FL Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material: ExistingPrivate Ft. Ft. Ft' _'&aq Driller: Date Drilled: Static Water Level: Installer: Date Installed - Ft. Flintstone Enter rises 8/26/2011 Yield: Pump Set at: Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ® Other: To Septic Absorption Lift Holding ubliGPrivate Manufacturer: Capacity: From Tank Field Station Tank Sewer Line Anchorage Tank 1000 Gel. 1 well 121.3 25+ Material: Steel Number of Compartments: 2 surfecewater 100+ LIFT STATION 13G5.2 Manufacturer Lol Line Gal. 78.4 'Pump off level at: 'Pump oW level al: High water alarm at: Foundation m. in. in. N/A Pump Make B Model Electrical lnspectionsperformed by: Curtain Drain Remarks Tank i Tnstallation only. BENCH MARK Location and Description: Garage FF Assumed Elevation: 100.0 Ft. Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1st 8/26/2011 nd ���••�•���e� OF.. 2 .•X\ ••....... C,-) Development Services Department Approval ° i ,! ' 49TH ; II Conditional Approval Date: ji Steven R Pannone.'i Reviewed by: Date: / �l I No. CE 8149 •�1 �...�..... and approved . (Rn. 04/06) �. 11,E ,��� C�da��C�C 87.8 I NEW 1000987.6 SEPTIC TANK SECTION COLLAPSED SEPTIC TANK ABANDONED PER CODE _ BY REMOVAL GREEN CONNECTED TO EXISTING DRAIN FIELD CRIB (E) 16'W x 16'L x 1 VD 135.2 HOUSE 9 NEW 10009 SEPTIC TANK �r 121.3 (E) 7i TANK W/ DCO BEFORE AND AFTER / A y G RAGE 38R 5 (E) WELL (E) HOUSE S E WELL (E) l3 10' UTILITY EASEMENT n / ELDER DRIVE is 91 W�W�W NOTES: A B Date 9 27/11 / �o Scale =so' Skyline View #1, Block 3, Lot 2 Mary Jane Haden P.O. Box 671122 Chu ick, AK 99577 9 DC1 28.8 25.8 — �9s T1 31.6 27.0 T2 37.3 30.1 � DC2 40.2 31.9 N p O O U N U � D H H D C�da��C�C 87.8 I NEW 1000987.6 SEPTIC TANK SECTION COLLAPSED SEPTIC TANK ABANDONED PER CODE _ BY REMOVAL GREEN CONNECTED TO EXISTING DRAIN FIELD CRIB (E) 16'W x 16'L x 1 VD 135.2 HOUSE 9 NEW 10009 SEPTIC TANK �r 121.3 (E) 7i TANK W/ DCO BEFORE AND AFTER / A y G RAGE 38R 5 (E) WELL (E) HOUSE S E WELL (E) l3 10' UTILITY EASEMENT n / ELDER DRIVE is 91 W�W�W NOTES: PAMONE ENG SVC, 1 • P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 �� or -A/ -_,,k \ � '��'•"••'•S1�j WN.. '�y�+ iir: 49 h1 * f • ""• ,,,... Steven Pannone ' CE 8148g 9 tit 4 1G043U•r 1 + Z 0�, Z � Date 9 27/11 / RECORD DRAWING Scale =so' Skyline View #1, Block 3, Lot 2 Mary Jane Haden P.O. Box 671122 Chu ick, AK 99577 9 P.I.D. NO 051-191-30 PERMIT NO. OSP111224 PLAN Sheet 2 On -Site Wastewater Disposal System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP111224 Tax Code Number: 05119130000 Work Type: Septic Upgrade Permit Effective Dates: August 26, 2011 to August 25, 2012 Design Engineer: PANNONE ENGINEERING SERVICE Subdivision: SKYLINE VIEW #1 Site Legal Address: SKYLINE VIEW #1 BILK 3 LT 2 GA 159 Owner/Address: HADEN MARY JANE PO BOX 671122 CHUGIAK AK 995671122 Site Mailing Address: 23023 ELDER DR, Chugiak Lot Size in Sq Ft: 108026 Total Bedrooms: 3 This permit is for the construction of: N Disposal Field Y Septic Tank N Holding Tank N Privy N Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Receivi Issued MUNICIPALITY OF r Community Development Department �jm' ,:✓/,f Development Services Division On -Site Water & Wastewater Program Mayor Darr Suffivan j N t ] ON-SITE SEWER/WELL PERMIT APPLICATION 1 • FOR A SINGLE FAMILY DWELLING Parcel I.D. j Phone: 907-343-7904 Fax: 907-343-7997 Property owner(s) 1 j jRy F+,Jj9t� Day phone Mailing address P,0. &2t &7ti 2z-, &Hoi_sA),(, Site address -2,S 2.3 &�j),c-2 ®ral)/z Legal description (Sub'd., Block & Lot) SKYL4, /C Ulct,�#) , R4,k3; u Z_ Legal description (Township, Range & Section) Lot Size 10%oZfv Sq. Ft. Number of Bedrooms —3 THIS APPLICATION IS FOR: THIS APPLICATION IS AN: (® all that apply) Initial E]Absorption Field ❑ Septic Tank K Upgrade Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: I certify that the above information is correct. I further certify that this application is being made for a Single Family Dwelling and is in accordance with applicable Municipal Codes. (Sig owner or authorized agent) Vof Rush Fees:�y ��- Waiver Fees: Payment:) ,SCE, Date of Payment: Receipt Number: UD I Receipt Number: Permit No. P t I � q Waiver No. GABuilding\On Site\Forms\Client Forms\Permit App_010411.doc (Rev. 1/11) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@panengak.com August 25, 2011 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: Skyline View #1, Block 3, Lot 2 Emergency Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new 1000 gallon Septic tank be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a three-bedroom house and is operating adequately for three bedrooms. The existing steel 1000 gallon tank is collapsed. The damaged tank is exposing the raw sewage to the environment. The existing tank will be filled with clean gravel or concrete and abandoned per code. The surrounding lots are served by public water, and there are no wells within 100 feet of the proposed septic tank. This lot is served by public water as well. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 2 slopes from southeast to nowthwest at approximately 6% in the area of the tank replacement. The proposed installation will be located in the central portion of the lot next to the existing septic tank and absorption system. Ilailhn : P,O, Box 1.0021.7. Anchorage., Al( 99510-021.7 0.021.x° Physical: 615 Fast 82..`s Ave, a,. ite B6, ncho-age, AK 99503 Telephone: 19037) 272-8218 FAX: (907) 272-8211. Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: iNi ig: P,O, Box 1.00217, Arc:hara e, AK 99 510 02-7 Physical: 615 Easy 82" Ave, Ctji e B6, Ar)6orag , Aid 99503 Telephone: (907) 272-821 FAX: 907) 272-8211 -p- 0 �O CRIB (E) 16'W x 161 x 1 VD COLLAPSED SEPTIC TANK (E) ABANDON PER CODE 1 GREEN 30.0 HOUSE 9 10009 SEPTIC TANK (P) (E) TANK W/ DCO BEFORE AND AFTER 1 ( 59 122,9 G RAGE 3BR (E) HOUSE WELL (E) E) E WELL (E) \ l� I I � 3 � o / 10' UTILITY EASEMENT tpa ELDER DRIVE = w \N J U NOTES:pANpNE ENG SVC LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 _--oF q \l r '<<G . L 4slll /�G>'�Qy++ *• TH "" • • ........... Steven R. Pannone � /PERMIT �� . CE 8149 j �, c liFp �'. l� PROFESS(30 Date 8/25/11 EMERGENCY TANK REPLACE Scale 1"=50' Skyline View #1, Block 3, Lot 2 Mary Jane Haden P.O. Box 671122 Chugiak, AK 99577 P.I.D. NO 17191-30 NO. xxxxxxxxx PLAN Sheet 1 OF 1 12/01/1998 12:36 3453287 M W DRILLING, INC PAGE 01 M -W DRILLING, Inc. P,O. Box 110378 • 70330 Old Seward Highway (907) 3498535 ANCHORAGE, ALASKA 99511 DRILLING LOO Well OwnerKnut on Use of Well -22°T,— Location (address of: Township, Range, Section, if known; or distance main roa L2. B3 Skyline View Subdiv No. 1 23023 Elder Street Site of casing—WL—Depth of Bole 290 —feet Cased to, Unknown feet Static water level -- G8 ---it. (s � . bWow) land surface. Minh of well (check one) open end ( X ) Screen ( ) ; Perforated Describe screen or perfos Well pumping test ats�l of drawdown from static Date of Depth to feet from ground surface --L—TO 16 D .... _ifiILTO zap _ —TO > (' Wuo (minute) for 9 .Moura with_.. 10" ft. .'ts. WELL bEEPENING }I Vit'. r• x .. WELL LOG od ' a lbrmations penetrated, size of material, color and hardness one gdllite, dark srev white and teen lenses aiSE th•:BDOradic small fractures and water. leaps. TO a TO I TO wV S a'�;"• t - r,' ..�t "., } y7d"y 'i;(v+\1�>};: iil- S?fi1 TOS —TO- O TO— �TO.. J TO— TO ti�lstz Pnunicipality O�T�?y & VIUn1a17 ,t rvlc e• TO— TO —_-..- -. _.._ Dept. Health TO— I -- CUSTOMER (falifirb Dfog b) DOC Co. tlba ' SULLIVAN WATER WELLS P.O. BOX 670272, CHLIGIAK, ALASKA 99567 • TELEPHONE 688.2759 OWNER OF LAND f�f>l,�R Y Kuj Iso J DEPTH OF WELL 160 _ ADDRESS a 6 0A. _ C;? 7 c) ' f (Z fue gccC 21 -C7 STATIC LEVEL OF WATER FT. - Z LEGAL DESCRIPTION 4 rq A'L/C, 3 SK ri,ri: u it7 l ntfj- DATE. - Started — Ended PERMIT NUMBER -11 6(�-1— 1 '11-�)0 KIND OF FORMATION: From O Ft. to-Q�—Ft. e,14 -,2"J6 STI 5 "to From C)Ft. to _Ft. 420E-06c14/01EfJ From.. Ft. to��) Ft. SeLVO From Ft. to Ft. a «S --- From Ft. to Ft.,40JQ /7.,'64 DRAW DOWN FT. GALS. PER HR , / KIND OF CASING 61-,o From.Fl. to! SLFt. 94F09O C < Froin Ft. to Ft.IAK7-Z- Sl= ✓� S From Ft. to Ft. c2:5 C From /5-( Ft. to Ft, From Ft. to Ft From Ft. to Ft. /r? Front Ft. to .Ft. From- - Ft. to c, - Ft. 6&6-L/-: L/: r- _ From Ft. to Ft. - From C � Ft. to a -7 Ft. ���'`�Q r G�/���- �- �t /� From Ft. to Ft. From{) ?Ft. toAT Ft._ Sig ! t l G,s ' .S�i � Q From NICIPALITY�F ANCHORAGE F a_BEP'I,�O From Ft. to Ft. f �-S RAcC ��CO�t,t � l-�c/ From ENVIRONME'� L PROTECTION Ft. to__ - 'x Ft. S'1`4 6 �A✓�L From Ft. to� 11.n !�� From Ft. to v'2__ From Ft. to Ft. °� ��' f P1 From Ft. to tt-W C 4 <-q A, 1 -,j (o,Q0qJ4?c From Ft. to Ft. From Ft. to From S < Ft. toFt. _/L/ sty°' (Fi9" /1 ���' From Ft. to Ft. From __Ft. to �i_� Ft. dZsl o& C K I¢� Vr-`c'l From_ Ft. to Ft. From Ft. to Ft. njd¢< From Ft. to Ft. From —Ft. to /43- Ft.61-�UK1)5�-C 17<`yR�l �^rL-t ^)From Ft. to Ft. MISCL. INFORMATION: C /' C 4j- ,-0 i r - I/ "O j L DRILLER'S NAME �`— M!�N�\�lPAL�l� �F ANCHURAS� De�artmunt ol ||eaiLK & Human Ser;ices 82� L SLreet, Ancho/a:e, Aiaska 99501 343^4720 ON-S|7E W!, LL Permi�|�um�er: U7V�/"� Up�ra�e Date /ssued; 1V/12/8/ Owner Name: PHYLLI� KNUiSON �wner Ad�res�: ��X 67�389 CH����K; AK 9956/ Uay Phone: 688~3121 1 arcei [A: 051-191-30 Lrt hap, i; Subdivision: SKYLINE VlEW 1S1 ADU Lot: to Block: 3 Section4 16 Township: 15N Ranqe: 1W Lot Size 108061 (scl.[t. or acres) �ax Dedr000�s: This Permit: 0 'An ial Capacity: 3 WELL: Log must be Aubmitted to Mu:icipality 01 Anchorage Department W Health and Human 13e10v1ces wbill in 30 days of well completion. AM US; WELL WILL REMAIN TIED INTO WATER SYSTEM. 1 /[�R|IFY THAT: 1. I am am! liar with +]'e i or o d wells et :orth by the Municipality of (city! an (MOA) and the State o{ 0i.aska. 2. l wi1l 111sLa1l Uie sysLem in accordance with all MOA codes and regulations, and in compiiance wiU� the desi�n criLeria of Lhit; permiL. 3. l wi]l ad|ere Lo a]1 MOA and SLY e oI A]aska requirements ; i)1 he set hack Jistances ;rom any existing *e1}; wastewater disposai system or pub1 1 seweraqe systcm on his or any enL or near!ty 1ot. � ] un�erstand ihat s permit is va}z1 or a maximux- u[ 0 bedrooms. l also understand U^,t ihe cavac zty o hn ut&11 0120 MI is 3 hed'o:ms an� any :nlsac c/eme:o wiil roquire an additional permit, Si�ned: DAlE: y,» Uwne�> ��YLLlS KNUTSU� i`�sued 8y� f-----��-~~-~`--^~~ � D�lL: y«�~/��-��7� -----~~~---'--- DOT BERRY DRIVE 327.24' �'� ELDER DRIVECLEANr SCALD 1'CALEi 1' a 50' 0 0 0 cr) Ch lHH /ELL AND SEPTIC SITE PLAN EGAL, LOT 2, BLOCK 3, SKYLINE VIEW 1st ADD, WNERi MR, AND MRS,_ HARRY KNUTS❑N aaoca •:j JJ v ."oaooagr ❑NTRACT❑Ri N/A AGLE RIVER ENGINEERING SERVICES �'`' Louis A. ❑ BX 773294 AGLE RIVER, AK, 99577'°`'fjoiFss���`_ 94-5195j�rle GRFTER ANCHORAGE AREA BO1UGH Department of Environmental Quality 0 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM NAME 1461"Y KV) uFSO N MAILING ADDRESS rrPHONE LOCATION Pr,11'4 IUAN VA4i.Gy Po_A0 LEGAL DESCRIPTION �i nlccic Jkywbjc- VIEW SEPTIC TANK: UL* /j�qy7U DISTANCE( (+ NUMBER OF FROM WELL J10 MANUFACTURER STl9Ct� �rCEG MATERIAL STEGE_ COMPARTMENTS INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH LIQUID CAPACITY 100 GALLONS. SEEPAGE PIT: NUMBER OF PITS�. DIAMETER (0'/' OR WIDTH Ebr, LENGTH Cb r , DEPTH LINING MATERIAL GUS CRIB SIZE: DIAMETER _kLDEPTHy' � DISTANCE FROM: WELL 13.3 r ((�� TOTAL EFFECTIVE BUILDING FOUNDATION=/0 , NEAREST LOT LINE Jai t ABSORPTION AREA (WALL AREA) SQ. FT. ADDITIONAL ABSORPTION WELL: TYPE Gf`(GLCj _CONSTRUCTION ✓r�N� %�l� DEPTH 160't- DISTANCE FROM: BUILDING NEAREST FOUNDATION LOT LINE CESSPOOL OTHER SOURCES APPROVED DISAPPROVED DISTANCES: INSTALLED BY: 7%12lIVGCP_&6K CX PIPE MATERIAL: 6 Z/1-70 LOT SLOPE: REMARKS: Form No. EQ -031 NEAREST SEPTIC ! SEEPAGE SEWER LINE -,TANK I/O SYSTEM X22 REMARKS <<0t, DIAGRAM OF SYSTEM L MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.Q. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # 051-191-30 1. GENERAL INFORMATION HAA # Complete legal description Lot 2, Block 3, skyline view #1 S/D Location (site address or directions) 23023 Elder Street Property owner Phyllis & Harry Knutson Day phone688-3121 Mailing address PO Box 670839, Chugiak, AK 99567 Lending agency Greatland Mortgage/Dalton Clark Day phone 243-1315 Mailing address 3201 C Street, Suite, 406, Anchorage, AK 99503 Agent .Tack Whi i-a/T y nn Swanson Day phone 242-2212 Addressll823 Old Glenn Highway, Eagle River, AK 99577 - Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XXX 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: XXX 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 MOAR21 r't J i (1 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 S & S ENGINEERING Q Eagle River Loop Phone G 9 N— h 7 G Address —_ Eagle River_ er�.1._ n ---- Engineer's „ P Road No. 204 Engineer's signature ryGa��/)' C �Z,n Date / a / a- / 9 53 6. DHH SIGNATURE Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 0 Date I Z � (0 J c' 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(Ray.1/91) Back MOAN21 RECEIVED Municipality of Anchorage DEC 02 1998 DEPARTMENT OF HEALTH & HUMAN SERMF9ALITYOFANCHORAGE Environmental Services Division ENVIRONMENTAL SERVICES DIVISlo 825 L Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 Health Authority Approval Checklist Legal Description: Lo + .1 OLK 3-V*YAwrrvi 6w -& / A. WELL DATA Well type P"2' vA T ✓z Parcel I.D.: OS-/ , / C7/ 3 0 If A, 13, or C, attach ADEC letter. ADEC water system number Log present &/N) Ya, s Date completed i Total depth ;�- O Cased to q0 — Casin hei ht (above round) Sanitary seal dy/N) _ 'Y & 5 FROM WELL LOG Date of test Static water level Well production 3 W g g Wires properly protected O/N) AT INSPECTION I'/„P d Y# S g.p.m. _ f 9— p.m- WATER SAMPLE RESULTS: Coliform J Nitrate © Other bacteria a Date of sample: f' -x r` t ( Collected by: S & S ENGINEERING17034 Eagle v r tOOP Road H -o-.70-4 B. SEPTIC/HOLDING TANK DATA Eagle !fiver, Alaska 99577 Date installed I q .n 4 _ Tank size I a "0 Number of Compartments .)- Cleanouts &/N) Y 6 s Foundation cleanout (Y/19- �' `� Depression (YO iJ u High water alarm (YA@ i" Date of Pumping I/ 1 / `i � Pumper T 01 ,s C. ABSORPTION FIELD DATA Date installed l -7q Soil rating (g.p.d./ft2or /b `�' �`S- _System type C Length I b r Width I `° r Gravel thickness below pipe —0 Total depth / l Effective absorption area 3 q CCA -C- Monitoring Tube present &N) y4 -f Depression over field (Y/169 No Date of adequacy test l ► / `I $ Results(Pass ail) I'll 5 1 For 3 bedrooms Fluid depth in absorption field before test (in.); �Immediately after/0u° gal. water added (in.): 3-1 Fluid depth (ins) Minutes later: 6 O Absorption rate = ^�5._ ° 4 g.p.d. Peroxide treatment (past 12 months) (Y/N) N a r ✓4 K Not -1 If yes, give date 72-026 (Rev. 3/96)* D. LIFT STATION Date installed Size in gallons _ Manhole/Access (Y/N) "Pump on" level at* �—i off level at* High water alarm level at* *Datum _ Cycles test E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100 /+ On adjacent lots _ /00 �4- Absorption field on lot /00 a' On adjacent lots r 00 11" Public sewer main — N / µ Public sewer manhole/cleanout N /4 r� Sewer /septic service line _ � r Lift station N 14 SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOTTO: Foundation s0 I -r- Property line / o o �-J Absorption field Water main/service line —/ --,L Surface water/drainageJ 00 4 Wells on adjacent lots /00, -1 - SEPARATION oo,i-SEPARATION DISTANCE F130MABSORPTION FIELD ON LOTTO: Property line 1010 -1- Building foundation o ' 4- ` Water main/service line / o 4 Surface water 100 + Driveway,o ` parking/vehicle storage area _ Curtain drain N 0 NK k ow „i Wells on adjacent lots / 0 0 '4- F. F. ENGINEER'S CERTIFICATION I certify that l have determined thru field inspections and review of Municipal records th •6cm�c'�+'oaa in conformance with MO gui elines in effect on this date. � 'e� f,, s are % Q. , ,.. ..107 .. Signature----�/? dZ✓ .r °'�`µ s'I0 f ��� Engineer's NameOV wA.� ,Y Y�� 0 � . •.OAJ� Date 1 �L / a. l S /. xotieRT c c iwn I A HAA Fee $1� Date of Payment Receipt Number / y 72-026 (Rev. 3/96)* Ma 7-d'-1,29 Waiver Fee $ Date of Payment Receipt Number C[-8CUI N '4` VES-Oi-08 10:10 FR064-CIE ENVIRONMEN1AL 5616301 AACT&F Environmental Services Inc. �w Y/LeJ►i6:R/fi/OI.RA�Ol�i//1JR�¢II CUF Ref.# Client Nattte Project Name/11 Client Sample W Matrix Ordered By PWSID Parameter Total Coliform Nitrate -N 986966001 S & S Engineering Lot 2 131k 3 Skyline view Lot 2 alk 3 Skyline view Drinking Water Results 0 0.201 0 PQL units T-033 P.02/03 F-067 Client PO>r Printed Dateillin a 12/07/98 11:17 Collected Date/Time 12/01/98 15:45 Received DateMme 12/02/98 13.05 Technical Director: Stephen C. Ede Released By MCTNod Cul /I00ml Sn18 92220 0.100 ng/L EPA 300.0 Allonable Prep Analysis Limits Date Oare Init 12/02/98 KAP 10 max 12/03/98 12/02/98 5GL MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 /� q Application Date t I 1 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) T,OT 2, BT OCK S: SEIMIM VIEW ADD #1 T15N9 R1W, SEC 16 Location (address or directions) FT T)FR STRFT+'T FA(—.TF, RTVFR (b) Applicant Name HARRY ENUTSON Telephone: Home 688-3121 Business NA Applicant Address P.O.BOX 67038941 EAGLE RIVER` AK 99567 (c) Applicant is (check one): Lending Institution ❑ ; Owner/builderl2; Buyer ❑ ; Other ❑ (explain); NA (d) Lending Institution ALASKA STATE BANK Telephone 277-5661 Address P.Q.- FOX 100240, ' ANCHOBAM,_AK -99510 (e) Real Estate Company and Agent n Address n Telephone na - (f) Mail the HAA to the following address: ACL PICKf TP BY FACT F RT`/FR FN IMEFRT jG SFRVTCF (,q q 2. TYPE OF RESIDENCE Single -Family MK Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well)M Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite 12X Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that basedon 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 _EACs F RTVFR FMCTi\E RTNG 4FRVICF9 Telephone 694-5195 Address P.O. BOX 77 294 PAM V r) [X Date Looe//•a� enencc.�+ o�e�e•�•.� Wa �� • Louis A. Butero . W ®� ee CE -6736 AO4�4�®�pROFESS10ta��AV CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional institutions in order to satisfy certain federal and state requirements. Employees engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANC.: i. -RAGE ENVIRONMENTAL SERVK-LS UIVR)ION 00 2 0 1987 RECEIVED A. WELL DATA Well Classification MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 Legal Description: LoU, block3 SVu1in \heu)*1 It A. B, C, D.E.C. Approved (Y/NI IZO V .✓tet >teie�( Well Log Present (Y/N) I Date Completed Yield Total Depth �6 D ' Cased to Depth of Grouting /✓Z _ Static Water Level `'/y /5c 0— /0 4 Pump Set At HNI/N Casing Height Above Ground do _ Sanitary Seal on Casing (Y/N) y Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot On Adjoining Lots t �o To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line en To Nearest Public Sewer .°✓/ Cleanout/Manhole ,- To Nearest Sewer Service Line on Lot Water Sample Collected by 14:s1�e e Date/ ­0// 7 Water Sample Test Results 0, 02-3 T Comments B. SEPTIC/HOLDING TANK DATA Date Installed A9741 Size No. of Compartments `:� Standpipes (Y/N) y Air -tight Caps (Y/N) _% Foundation Cleanout (Y/N) �U Depression over Tank (Y/N) Al Date Last Pumped Pumping/Maintenance Contract on File (Y/N) ; for "/ Holding Tank High -Water Alarm (Y/N) /'�/ti Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Well �S 5 To Property Line To Water Main/Service Line Course / Comments Page 1 of 2 72-026(11/84) To Building Foundation To Disposal Field /5 ,7v To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata �5 PJ>" �"� Type of System Design S 5,"6sQ Date Installed /y 2 -� Length of Field �G Width of Field 16 Depth of Field Gravel Bed Thickness r Square Feet of Absorption Area Standpipes Present (Y/N) Y Depression over Field (Y/N) l✓ Date of Last Adequacy Test io%/;>= Results of Last Adequacy Test � 1�rs 75-t rx XIZsn A lle ✓ /Z4 A--fo, /1C Separation Distance from Absorption Field: To Water -Supply Well To Building Foundation ` Lot /`X/4 To Water Main/Service Line r/,a To Stream/Pond/Lake/or Major Drainage Course _ To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION /� Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments To Property Line To Existing or Abandoned System on On Adjoining Lots 4-30 ` To Cutbank (if present) t ie Dimensions Manhole/Access (Y/N) — "Pump Off' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed — 5 Date lo IES Company ��'� MOANo. Receipt No. O 0 U c�13 Date of Payment Amount: d E{jineer's Seal „ 7 EO 8'J. .�., P.. t, l:t(l v -L O., "eG�-J;]®OL ()( ✓'� Cf �( o3-onwpupae, ao�n^no aun no o°e, a i �., " Louis AP.u; . rra oc t <l Page 2 of 2 c>,, o (:k 6736 fr 4(f V> )(Bnn En(;in O9�ev 72-026 (11/84)q /;