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HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 1 LT 3Akyway Park Estates Block I Lot 3A #019�141�09 Municipality of Anchorage Development Services Department Sulkling Safety Division On -Site Water and Wastewater Program, 4700 Elmore Road P.O. Box 1 9W50 Anchorage. AK 99507 Page of wwvv ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DisPOSALSYSTEMANDIOR WELL INSPECTIONREPORT Permit Number. SWO50344 PID Number 019-141-09 k� Ralph & Zenobia Bowman Wastewater System: El New 0 Upgrade A� 11701'royDrive Anchorage,AK99515 ABSORPTION FIELD pf� 349-0410 kl� of ll� 3 CIDSWTV� RJS�T 0 OW Cl� 13 O� LEGAL DESCRIPTION sal�' 4 T" DWM � a" WtK1,1 3 ct�we Ft. 81=x La s� I 3A Skyway Park Estates 2 G� d.M Pow Ft. ft Townvv R -W s� Fg��W"W� G� 2-3 Ft. 25 Ft. Well: El New Upgrade 5 Ft C� (�. A, S. Q T" DOM C� 0 T" abtp� . P" Existing 1 R. Ft 125 Fe, ASTM D3034 PVC D� VM � ID -M a Alaska General Industries 1 9121=05 Y� ft� C".V hw"� �Ft TANK GPIJ Fj SEPARATION DISTANCES 0 Seplic 0 Holding 0 STE.P. 0 Other. To Septic Absorption Lift Holding 'ublrJPnvtiit8 M�� cw�y F� �_� Tank Field Station Tank S�rtjft Anchorage Tank/Orenco Systems 11.500 I M� � a vva >100' >100' NIA WA >Z5 Steel Two (2) satt,t,i,w� >100' >100' N/A WA LIFT STATION wuw 3' 1. N/A WA F� >5! >10' I N/A N/A in E� lnlp� 900o Dr C� Ctm, None Noted Muni. of Anchorage R� BENCH MARK Gravity Flow to Absorption Trench. L� D .. P� Existing Septic Tank Pumped, Crushed and Removed. Garage Stab See Lot Line Waiver. A....d LZ� 100.0 Ft Er Inspections performed by: A. Harala Dates: 10 9121/2005 �#.�Vbrv% t -OF A4 tit 2-d 9/21/2005 !f Development Services Department Appro Conditional Approval ... .... ..... ... -Date: .. ................... .... .. E ERSON 81 by: e'��Xte: illkPeOFE Reviewed and approved Municipality of Anchorage DEVEOPMENT SERVICES DEPARTMENT 4700 Elmore Road Anchorage. AK 99519-6655 - 343-79134 On -Site Wastewater Disposal System or Well inspection Report Existing Well 0 KLATT ROAD PLAN AS—BUILT SCALE V z: 40' Page 2 of 3 PID No. 019-141-09 A 1 8 99' 28V MH 117E,TL ET 30 C2 55' ISM C3 45.8' Z 44.1' 52.3' ................ A a" �v I LP : 49th MICHAEL F ANDERSON No, CE -4361 Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK 99519-6655 - 343-7904 On -Site Wastewater Disposal System or Well Inspection Report Permit Number. SW050344 PID No. 019-141-09 02.2 Filter IMP'c 1,250 Gallon Advantex Septic Tank 97.0 ,r U 99.2 Geotextile Fabric 95.8 Drainfield Rock 7- 94.87 %W—O. 25'(Trench Length) _I m 90.7 915105 88.2 49 0 .. .. .. .. ... .............. PROFILE AS—BUILT 0 KI .0. 0 1 X NoScale 0 Permit Number: SWO50344 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water& Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Sep 12, 2005 Expiration Date: Sep 12, 2006 Parcel ID: 019-141-09 Legal Description: SKYWAY PARK ESTATES BLK I LT 3A Design Engineer: 00 14 Anderson Engineering Site Address: 011701 TOY DR Owner Name: RALPH & ZENOBIA BOWMAN Lot Size: 24203 SO. FT. Owner Address: 11701 TOY DRIVE Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99515 - This permit Is for the construction of: E Disposal Field F-71 Septic Tank E] Holding Tank E] Privy E) 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 AJaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DSD at least 2 hours prior to each Inspection. Provide notification by calling (907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, sealed, and heated to prevent freezing. 5. The following special provisions. -NEED TO SURVEY AND STAKE PRIOR TO CONSTRUCTION TO MAKE SURE THE SEPTIC TANK AND LIFT STATION ARE 100 FEET FROM WELL. Received By. Date: Issued B Date: 9,111.7 JoT— I I Municipality of Anchorage P0. Mix IOCCA50 - Anchomgc, Almqka VZMCMA) a Telephone (907).M3.P.301 - r" ('X)7) 343-8-M) i 614 il �_ 0 1. 4700 11nipw Stmet - Anchomge, Alaska 91.M7 %MW."luni.org Mayor Mark Begich Building Safcty Division September 12,2005 Alichael E. Anderson Anderson Engineering P.O. Box 240773 Anchorage, AK 99524 Subject: Waiver Request for Skyway Park Estates Block 1 Lot 3A Waiver Request WRH: 050072 Parcel ID # 019-141-09 PERMIT # SWO50344 Dear Michael E. Anderson: Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. Tbc approved separation distance is 1.0 foot lot line waiver from trench to west property line. 11is waiver approval applies to the existing absorption field to property line separation only. Any future upgrade to the on-site wastewater disposal system will require all separation distances be met or another approval from this department. If there are any further concerns or questions regarding this waiver, please call our office at 343-7904. Sincerely, c VOoodall Civil Engineer On -Site Water & Wastewater Program Cominuitity, Security, Prosperi(y Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 South Bragaw St P.O. Box 196650 Anchorage, AK 99519-6650 www.ci.anchorage.ak.us (907) 343-7904 ON-SITE SEWERNVELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING 5 A I I Parcel I.D. 0 q - I L4 1- 09 Permit Number SW Property owner(s) Ralph and Zenobla Bowman Day phone 349-0410 Mailing address (1) 11701 Toy Drive Anchorage, AK 99515 Mailing address (2) 11701 Toy Drive Zip Code Legal description (Lot, Block & Sub'd.) Lot X Block 1. Skyway Park Estates Subdivision Legal description (Section, Township & Range) Lot Size 9LIZ-13, creie) Number of Bedrooms Three (3) THIS APPLICATION IS FOR: Sewer Only 1:1 Well Only El Sewer and Well El Water Storage El Sewer Upgrade 0 THIS PROPERTY CONTAINS: Hot Tub E3 Jacuzzi El Swimming Pool El Water Softening Unit Therapy Pool El 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. (Signature of property owner or authorized agent) Permit Fees: P !� -t- 3 175r!! #Aol 00 Waiver Fees: it /7S-" n - Date of Payment: Date of Payment: Receipt Number Receipt Number (Rev. 12100) ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) September 9, 2005 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 3A, Block 1, Skyway Park Estates Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer: The existing septic system on the subject lot has failed and must be replaced. Very little surface area remains on the lot outside the protective radii of the well on the lot and the well on the lot to the north. We have therefore decided to place an Advantex Treatment System on the lot to provide the most effective treatment of the septic effluent prior to discharge into the surrounding soil strata. The location of the absorption trench is shown on the attached Site Plan. Additional documentation is furnished which identifies the absorption trench in relation to the existing well on the lot and on adjacent lots. The test hole placed on this lot revealed silty gravel with some sand. The percolation rate in the materials encountered was 4.5 minutes per inch. Groundwater was found during the excavation 7.5' below the surface and stabilized at 7.1' below the surface during the monitoring period. We are therefore proposing to place a three-bedroom Advantex Treatment System. The absorption trench will be 25' long x 5' wide with a 11' effective depth. The distribution line in the trench will be placed 1.5' below the existing ground level. The total depth of the trench will be 2.5' below the ground. 3' of fill will be placed above the trench and 4' over the septic tank to meet Municipal Code and prevent freezing. The ground surface of the lot is basically flat with only minor grades. The absorption trench will be constructed parallel with the slope as much as possible in conformance with Municipal requirements. All components of the new septic system will be constructed a minimum of 100'from any surface water and 100'from the well proposed for this lot. It will also be constructed a minimum of 100' from the well on the adjacent lot. Lot 3A, Block 1, Skyway Park Estates September 9, 2005 Page Two If the system is constructed in accordance with our design the following statements apply: The system, if constructed as designed, will have no adverse impact on the wells in the area or those to be constructed in the future. 2. The system, if constructed as designed, will have no adverse impact on existing septic systems in the area or those to be constructed in the future. 3. The system, if constructed as designed, will have no adverse impact on reserve space, either surface or subsurface, on any lots located in the area. 4. The system, if constructed as designed, will have no adverse impact on drainage patterns in the area. The current drainage pattern will be maintained. Sincerely, Michael E. Anderson, P.E. Attachments 49th MCIIACL L. ANOtRSON NO CE -4381 ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 September 12, 2005 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program P.O. Box 196650 Anchorage, AK 99519-6650 Subject: Lot 3A, Block 1, Skyway Park Estates Subdivision Separation Distance Waiver Absorption Trench to Lot Line Dear On Site Services Engineer: The absorption trench on the subject lot has failed and must be replaced. The location of the well on this lot and the lot to the north restrict the area available for an upgrade. We are proposing to place an Advantex Treatment System to minimize the required absorption area. Unfortunately on a small area remains and much of it is closer than 10' to the west property line. We are therefore requesting a waiver to allow the construction of the new absorption trench at 1' from the west property line. This lot line is adjacent to the 60'wide right of way of Toy Drive. The placement of the absorption impact on the surrounding lots systems or wells. We therefore from the west property line. Sincerely, 1",i, E iL� Michael E. Anderson, P.E. trench within 1' of the west property line will have no and will not encroach into areas reserved for septic request a waiver be issued allowing the trench to be 1' SKMAY PARK ESTATES LOT 3A, BLOCK 1 0 Existing Well 110.47 10' Utility Easement (D CNI v 6 CO 25' Lo X 5' Wide 2' EWIcthn, Depth * Ab rptlon Trench Three Bedroom (D Home OTH I Isting Septic Am roe Bedraorn Advantex Treatment System With AX20 Pod & Add On Uft Station CIq 00 C14 C-4 (9 0 Existing Wall 60.82 NOTE.- Remove Existing Septic Tank and Pooperly Dispose. Rannave Contarnfinattle,n From Old AMptlan Trench Within to' of , Trench Old Klatt Road 4�41� OF "N .......... As 4 ..... ..... ...... .......... ...... I ..... SITE PLAN ..... ..................................... MI EL E.. SCALE 1"z: 40' . ......... 444 44 LOT 3A, BLOCK 1 , SKYWAY PARK ESTATES SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Three Bedroom Home Advantex Treatment System for Three Bedroom Home Perc. Rate: 4.5 Min./inch 500 Gallon Lift Station w/ Pressure Distribution System Application Rate: 4 GPD/SF 5' Wde Trench with I'Drainfield Rock 3 Bedrooms x 150 GPD/Bedroom/4 GPD/SF (Application Rate) = 112.5 SF Absorption Area 112.5 SF/5 SF/LF = 22.5 LF Trench Length THEREFORE: Construct a 25' Long x 5'Wide x I'Effective Depth Absorption Trench. Flow Line Elevation in Trench to be 1.5' Below Original Ground Surface. Total Depth to be 2.5'Below Existing Ground. Provide 3'Cover Over Absorption Trench and 4'Cover Over Septic Tank. In Lieu of Fill Place 2" of Direct Bury Insulation and 2" of Natural Cover. 3' Depth 1-6- Natural Backfill Geotextile Fabric 6- 1" Perforated PVC (Holes Down) 1'0" 24-3/16" Holes @ I'Spacing Drainfield Rock 5- TYPICAL 5'WIDE TRENCH SECTION (NO SCALE) d NOTE: Grade Area Over Trench to Drain Away. Minimum 6'Separation From Bedrock. Minimum 4'Separation From Groundwater. Minimum 1 OO'Separation From Wells in the Area. Minimum 1 00'Separation From Surface Water or Streams: No. cc�i Performed For. Legal DescTiption: j ---- I Municipality of Anchorage Development Services Department Building Safety Division On -She Water and Wastewater Program 4700 South Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 .... . .. .... tn�=Ijnchoraae ek us ':�%hUCHAZL 1. ANDERSC)m 4907) 343-7904 4' -;�.% CE -4301 e Soils Log - P ircolation Test tit �?Orfsswk�;itI� Ralph and Zenoblat Bowman Date Porto ed: . '. . .. .. 9 1 �A_ jNW Skmay Pk.. Estates, L 3A, . Blk I Township, Range, Section: T� I , '115- 17 - COMMENTS *> 04 4; 41 IL I WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Depth to Water After oL MonItorInj7 P E F�eadlng main NE01 Gniss Time NetTlme Depth (0 Water I 1001,1011 Nolan 01101010 1010100 01101010 MMIANE WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? Depth to Water After oL MonItorInj7 P E F�eadlng Dale Gniss Time NetTlme Depth (0 Water Net Drop 157, 4 r 1q,.16:5c, 1,q. 5 1�, le,� PERM ATInN D.;7. U E--- =77— -VLM V�L ILK TEST RUN BETWEEN F'f �AND— 4-cr FT PERFORMEDBY: CERTIFY THAT THIS TEST WAS PERFORMED IN'APCORDANCE WITH ALL —STATE AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE. DATE: 09/09/2005 14:17 FAI 907 343 7097 ON SITE ADVANCED WASTEWATER TREATMENT SYSTEM MAINTENANCE AND REPAIR AGREEMENT MEMORANDUM OF UNDERSTANDING BETWEEN MUNICIPALITY OF ANCHORAGE AND THIS MEMORANDUM OF UNDERSTANDING made and entered into as of this — day of of 20. by and between herein the "OWNER," and the Municipality of Anchorage, herein the "MUNICIPA.LrrY." In consideration of the mutual covenants contained herein, the parties to this Memorandum of Understanding agree as follows-. 1. ADVANCED WASTEWATER TREATMENT SYSTEMS. Municipality grants permission to Owner to utilize and operate an Advanced Wastewater Treatment System (AWWTS), described as Advaintex Treatment located system fit Lot 3A, Block 1, Skyway Park Estates Anchorage, Alaska. 2. Definitions. A. Alteration. Any change to the design or function of an AVYVTS that includes the installation or removal of any parts, components or pieces not included in the original construction permit and design. Prior to performing any alterations to an AWWTS the owner must obtain a Wastewater Disposal System Construction Permit from the Municipality pursuant to Anchorage Municipal Code (hereinafter, "AINIC") 15.65. B. Certificate of On -Site Systems Approval. An approval by the Municipality of existing water and wastewater disposal systems given at the time of property sale and title transfer in accordance with AMC 15.65. Zool 09/09/2005 14:17 FAX 907 343 7997 — ON SITE These approvals certify that the systems are adequate for the homes that they support and meet the codes that were in place at the time Of system construction. C. Damage. Any man-made or natural change in a system that would inhibit the system from performing as designed. D. Maintenance and Repair. The scheduled and as needed replacement of existing parts, components and pieces of an AVrWTS that were included in the original design which would allow the AWWTS to continue to perform as designed. E. Permit (Construction) An On -Site Wastewater Disposal System Construction Permit as defined by AMC 15.65. F. Permit (Operating) An Advanced Wastewater Treatment System Operating Permit An annual permit, issued by the Municipality, that allows the Owner to operate an AWWTS, upon meeting all the requirements of this agreement, the conditions of Operating Permit, the requirements of the On -Site Wastewater System Construction Permit and all relevant provisions of AMC 15.65 3. Fee. Owner shall pay to Municipality an annual fee of 0 (None) ($_.00), payable on or before the issuance of the operating permit and annually thereafter. The annual fee is due on or before the anniversary date of the approval by the Municipality of installed system. 4. Term. The term of this Memorandum of Understanding shall be for the life of the AWWTS. IZO02 09/09/2005 14:17 FAX 907 343 7997 — ON SITE Z 003 The term begins on the date of approval by the Municipality of the installed system and shall continue while the AVVTS system is in use or operational or until the property is sold or title is transferred by owner and a new certificate of On -Site approval is issued to the new owner or transferee of the property. 5. Alterations, Installation and Removal of Additional Eguipmen . Owner agrees not to make any alterations, removal of parts or additions to the AV4rWTS without a Construction Permit from the Municipality. 6. Maintenance and Reval". A. Throughout the term of this Memorandum of Understanding, the Owner shall maintain AWWTS in good repair. In addition, it shall be the responsibility of the Owner during the term of this Memorandum of Understanding, and any extensions or renewals thereof, at the owner's sole expense, to pay for any and all: (1) repair(s), (2) maintenance, (3) adjustment(s), (4) replacement costs, and (5) inspection costs. Further, Owner agrees to comply will all applicable ordinance, laws, regulations, rules and orders for the AWWTS. B- Owner agrees to provide the Municipality a written schedule of routine maintenance and repairs which have been performed on the system pursuant to the terms and conditions contained in the Owner's AWWTS Operating Permit. This schedule shall be submitted to the Municipality annually upon the renewal of the permit. The schedule of maintenance and repair contained in the Owner's AWWTS Operating Permit is: C. Owner acknowledges that the fine schedule for failing to maintain and repair an AWWTS are codified in AMC 14.60. 09/09/2005 14:18 FAX 907 343 7997 - ON SITE Q004 D. Owner agrees that only maintenance, repair personnel certified by the Municipality will inspect and make any necessarymaintenance, repairs or permitted alterations to the system. E. Owner agrees to grant the Municipality reasonable access to test and inspect the AWWTS upon 24 hours written notice. F. Owner agrees that any sale or transfer of tide of the property will not occur without a new Certificate of On -Site Systems Approval. G. Owner agrees that the relevant provisions of the standard specification guidebook for AWVrTS is the governing professional guidelines for the construction, maintenance and repair of the Owner's AWWTS. 7. Nouwalve . The failure of either party at any time to enforce a provision of this Memorandum of Understanding shall in no way constitute a waiver of the provisions, nor in any way effect the validity of the Memorandum of Understanding or any part hereof, or the right of such party thereafter to enforce each and every provision hereof. 8. Amendment. A. This Memorandum of Understanding shall only be amended, modified or changed by a writing, executed by authorized representatives of the parties, with the same formality of this Memorandum of Understanding was executed and such writing shall be attached to this Memorandum of Understanding as an amendment. B. For the purposes of any amendment modification or change to the terms and conditions of this contract, the only authorized representatives of the parties are: SEP.12.2005 12:35 3490409 BOWMAN MECHANICAL Sep. 12. 2005' 4:40AM' "andtrson Mint"ineri 31TE Owner F;�-T-11-[-Tr I., M-;,Tln #5507 P.001/001 hCAW r. t ... C. Any attempt to anicad, modify, or cWgc this contract by either in unauthorized representative or unauthorized Means shall be void. 9. jorisdictionLQ91ce of jg&w. Any civil action arising from this Memorandum of Utidastagiding %WI be brought in the Superior Court for the Third Judicial District of the State of Alaska at Anchorage. The laws of the State of Alaska shall govern the fights WA obligations of the partics under this Mcinomadurn, of Underrstaiiding. . lo. agymbillty. Any provisions of tjsMcmotWum of UtiderstaAding dectced ivalid by a cow of compctcritjurisdiction shalt not invalidate the remainisig pro%isions of the Memorandum of Understanding. ONMERT BY- a" STATE Of ALASKA THIRD JUDICIAL DISTRICT Imilmell By: :Title: Date: The foregoing instrument was acknowledged before; mc this a, day of Se 20 Qj-� by the of on behalf of the Municipality of Anchorage. NOTARYjfUBLIC FOR ALASKA my commission expires: OY- 9-61? 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 O'NEW E]UPGRADE --acLLE MAILING ADDRESS LEGAL DESCRIPTION LOCATION NO. OF BEDROOMS DISTANCE To. Absorption at an Dwelling PERMIT NO Wall /0( 690 -XII? U, �5V -151 PZ to Manufacturer Matem9l No, of compartments QQ U(j. capacity in gallons Inside length Width IF HOMEMADE: Liquid depth C welling PERMIT NO. 02< f- Manufacturer Liquid capacity in gallons -- 0 to to � u. � Wall IS [ANCE TO; D —larL.— No. of lines Length of a h line Foundation I Nearest lot line 7 Total length of lines Trencl *dtl PERMIT NO. —,-(IF) Distance between I ines F��ua CC :-? I Ll' - -�- ( Inches c-, , (P — < 't- 0 Top of tile to finish grade ---J — - -- -Q Matenal beneath tile inches Total effective absorption area an Length Width Depth PERMIT NO. Q) at� �r to Type of crib C-r—iffidi—ametet Crib depth Total effective abso, ption cu ea W DISTANCE TO: Well — Building foundation —Nea-re—stlot —line U1 Class DISTANCE TO: Depth Building foundation Differ Sewer line P Distance to lot Hne PERMIT NO. Sep Absorption area (s) OTHER PIPE MATERIALS SOI L I EST RATING 83 INSTALLER 0 � ;j I k 117 REMARKS 1 4- ', 6 '(1 ( j. 31 am* 0. ulbot 91; 'Zler- /M9�E LEGAL rP -PR 7 -ED DATE /Wo 72 013 (Rev. 3178) N 11 Li PA 1 C.: I F"r-1 1 311- I -e 1" -*a F� F"I V4 I::. U-1 cl rzi FEE DEPARTMENT _- HEALTH AND ENVIRONMENTAL 0TECTION 825 "n STREET, ANCHORAGEP AK 99w0l 264-4720 CH FA I -IF EF. IiHEE 1 -4 I=E FR F� FE r-� rel 11 - PERMIT NO. 4 800425 ) APPLICANT SCOTT MYERS 4509 CASSIN DR. 276-8106 LOCATION KLATT & TOY RD. LEGAL LOT 3A,BLK I SKYWAY PK EST.� LOT SIZE 22000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: DRAINFIELD MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SQ FTIBR)= 85 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: EAEEF�"T-1-1­ It L_lE0VAjCC-i-rI-I=- -2- C.. P3 Fe F -i I..." EE L_ r-.EEF­rs­&== :2 THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF A TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET). -1-8-91EE _T_F_ U-31-401-1 L-A T C.-T'l-I 1 �5-. CMERC24 r—F THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). FEE> "TE=0-F-,ToZ­ �-.512ZEE== PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE INSTHLLATION INSPECTION$ OF ANY WELLS ADJACENT TO THIS PROPERTY AND THE NUMBER OF RESIDENCES THAT THE WELL WILL SERVE. ki C-il of ;2 "lo 1 1"A f -:". f �- C- IZ'- -r I CZ, 1'-4 n F."FEE. FC F_ 17! IJ I F-` EE 17�� --- --- - — BACKFTLLING OF ANY SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON-SITE SEWAGE DISPOSAL SYSTEM IS 100 FEET FOR A PRIVATE WELL OR 150 TO 200 FEET FROM A PUBLIC WELL DEPENDING UPON THE TYPE OF PUBLIC WELL. MINIMUM DISTANCE FROM A PRIVATE WELL TO A PRIVATE SEWER LINE IS 25 FEET AND TO A COMMUNITY SEWER LINE 15 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. FOEEIARPI 3" 1- EETZ& 3"FRES"s I CERTIFY THAT 1: 1 AN FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE RESIDENCE 15 REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED --------------------------- AP ISSUED BY- w7l AND WELLS AS SET ENLARGEMENT IF THE Y4. 0 N MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pou,h "60, Ancliar,go, Alaska 99502 276-2221 IN, *– SOILS LOG — PERCOLATION TEST PURFORMED FOR: A LEGAL DESCFtlf'rl0W- 41 --- tF E T C 3 C-). 5 7 c" U 9 DATE PERFORMED: �( Sol I.'S LOG FJ PERCOLATION TEST 61 1 h. PLAN 10 : ; WAS GROUND WATER �) � /') s 11 ENCOUNTERED? L�- 0 P 12 E. ff- YES ' A r WHAT D -rii EP ? 13 14 'Date G, oss Time 15 Death to Water Not Drop 4 16- 17 - 49u, .. . ...... ... is- acomh Talbot 19 NO. 9-E Reading 'Date G, oss Time Not Time Death to Water Not Drop I .. ... -0 20 - 51; PERCOLATION RArL TEST 13UN BETWEEN COMMENTS PEFIF OHMI D 13 72 008 (IJ76) CER11FIED BY (minutesbrich) FT AND FT UATE:-�cz Mac w".1 A, A, yj', . ..... . ................ . ..... ... .... 10, . .. ... ....... ...... Dld� C0111pIpAnd 3 ...... ..... . ..... .. ......... Dept 11 of 'woli... ......... I ll�' ....I .... c.. .............. . ... ..... . ....... ...... ............ ......... I. . ........ ..................... . I ........ . .. ;01 .. A. . D)sUmCc to N'l,jt<'r Whil f! I' Ll .......... I lite ol ........ ....... 1�& liuwx. .. .......... . ........ ... G'I a v 40 T Sr' r. 'r (IF th it t I , c.v! 1 r). U, tr�:c :I!!,! FOSS DBILLING ALASKA 1�5)1 w. MUNICIPALITY OF ANCFICIRAGL" DEPT..OF HEALTH & ENVIRONMENTAL PROTECTION. vlA� 0 41986 RECEIVED I%,: yf)%, (1, :Itttivil H,.ts cctimcnt�I to your (Icce . ..... . ................ . ..... ... .... s'; r I p L I o n o' . .. ... ....... ...... Dld� C0111pIpAnd 3 ...... ..... . ..... .. ......... Dept 11 of 'woli... ......... I ll�' ....I .... c.. .............. . ... ..... . ....... ...... ............ ......... I. . ........ ..................... . I ........ . .. ;01 .. A. . D)sUmCc to N'l,jt<'r Whil f! I' Ll .......... I lite ol ........ ....... 1�& liuwx. .. .......... . ........ ... G'I a v I , c.v! 1 r). U, tr�:c :I!!,! FOSS DBILLING ALASKA 1�5)1 w. MUNICIPALITY OF ANCFICIRAGL" DEPT..OF HEALTH & ENVIRONMENTAL PROTECTION. vlA� 0 41986 RECEIVED I%,: yf)%, (1, :Itttivil H,.ts cctimcnt�I to your (Icce s'; r I p L I o n o' �,'6 r L-0 I-.! t-7 a r r o n i JQ nd (D'a v (I B), 1) 0 A V 140 G'I a v 40 T Sr' r. 'r (IF th I , c.v! 1 r). U, tr�:c :I!!,! FOSS DBILLING ALASKA 1�5)1 w. MUNICIPALITY OF ANCFICIRAGL" DEPT..OF HEALTH & ENVIRONMENTAL PROTECTION. vlA� 0 41986 RECEIVED I%,: yf)%, (1, :Itttivil H,.ts cctimcnt�I to your (Icce 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 I.D. # 019-141-09 1. GENERAL INFORMATION Complete legal description HAA # S'___waY Park Estates Lot 3A, Block 1 Location (site address or directions) 11701 Toy Drive, Property owner Ed Larson — Day phone 243-3378 Mailing address P.O. Box 110130, Anchorage, AK 99511 Lending agency City Mortgage/j.. DiMaggio Day phone Mailing address P.O. Box 92810, Anchorage, AK 99509 Agent Address Day phone Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 '4 3. TYPE OF WATER SUPPLY: Individual well X Community well Public water 263-0738 NOTE: If community wet/ system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site X Holding tank Community on-site Public sewer NOTE: If community wastewater system, Provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (RO�- 1/91) Fr,�l M01 121 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 forthe 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 Eagle River Engineering Services Phone 694-5195 Address P -o. Box 773294, Eagle Riyer, AK 99577 Engineer's signature 6. DHHS SIGNATURE _X_ Approved for iz�15__%d rooms. Disapproved. Conditional approval for Additional Comments 0 Date wk 'o I " 5 t ell .0-A Li�,;, A. UN. bedrooms, with the following stipulations: 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 theStateof Alaska.The DHHS does this as a courtesy to purchasersof homes andtheirlending institutionsin order to satisfy certain federal and state requirements. Employeesof DHHSdo 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 engineers work. 7M25 (R.� Inl) B.ck MOA #21 MUNICIPAL" OF ANCHORAGE ENVIRONMENTAL $ERVICES�;�ISIONI Municipality of Anchorage JUL 03 1 DEPARTMENTOF HEALTH & HUMAN SERVICES C*3 Environmental Services Division 825 L Street, Room 502 9 Anchorage, Alaska 99501 e (907) 343-9K E I Health Authority Approval Checklist Legal Description: SIZ Y �Vll Mk fi� I- S 7A -TC�S; Parcel I.D.: A. WELL DATA Well type M �lr If A, 13, or C, attach ADEC letter. ADEC water system number V14 Log present (Y/N) V66 Date completed 0(�Zo-;A// Total depth 5F Cased to '�-7 Casing height (above ground) Sanitary seal (Y/N) Date of lest Static water level FROM WELL LOG 06 V Well production 7� 15 WATER SAMPLE RESULTS: Wires properly protected (Y/N) Y16 AT INSPECTION n'b"715? 9 -P.M. 0 g.p.m. Collform Nitrate Other bacteria Date of sample: 00 Collected by: B. SEPTIC/IHOt011iNG TANK DATA Date installed lillplg'!) Tanksize �o Number of Compartments Cleanouts (Y/N)- YI�S Foundation cleanout (Y/N) Depression (Y/N) -ZV�-- High water alarm (Y/N) —1'11A Date of Pumping -a2,&2/-9(V-Pumper—/5H//e/S C. ABSORPTION FIELD DATA Date installed // //,;, / F'9 Soil rating (gp,d4ft`-or ftl/bdrm) S�5 System type­/L-zc/v�-/� - Length. 3,',.. ) re�k�e Width_ Gravel thickness below pipe 21 Total depth 1� /- Effective absorption area Monitoring Tube present (Y/N)--Y- Depression over field (Y/N) 0 AA - Date of adequacy test 70- 'IM- Results (Pass/Fall) 10115S For —bedrooms Fluid depth in absorption field before test (in.); _/5- Immediately after� L�10 gal. water added (in.): Fluid depth - /11 (ins) Minutes later: /,;� 71 Absorption rate = — 7' p, d. Peroxide treatment (past 12 months) (Y/N) 72-026 (Rev. 3/96)* A If yes, give date � MA D. LIFT STATION Date in stalled Manhole/Access (Y/N) High water alarm level at* E. SEPARATION DISTANCES *Daturn SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/hdtfing tank on lot 7'100 Size in at* On adjacent lots Absorption field on lot (LIZ qbool-L) On adjacent lots I I Public sewer main Sewer -/septic service line "Pump off" level at* Public sewer manhole/cleanout Lift station /-/00 / SEPARATION DISTANCES FROM SEPTIC/HOLMNG TANK ON LOT TO: Foundation Property line Absorption field Water-main/service line Surfacewaterldrainage Wells on adjacent lots SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line Building foundation Water main/service line /0 Surface water Driveway, parking/vehicle storage area Curtain drain A/dA/4' IVXI/ /?- 6��l 7 -Wells on adjacent lots F. ENGINEER'S CERTIFICATION I certify that I have determined thru field Inspections and review of Municipal t t Is are in conformance with MOA HAA guidelines in effect on this date. % Signature ....... Engineer's Name E -6 - Date HAA Fee $ Waiver Fee $ DateofPayment Date of Payment Receipt Number /l/c a5-0 2 Receipt Number 72-026 (Rev. 3/96)* Altuileipahty of Anehorage Department of Health and Human Services Rick Mystrom, Mayor April30,1996 825 "L" Street P.O. Box 196650 Anchorage, Alaska 99519-6650 Lou Butera, P.E. Eagle River Engineering Services PO Box 773294 Eagle River, Alaska 99577 Subject: Waiver Request for Lot 3A Block I Skyway Park Estates Subdivision Waiver #VVR960012, PID #0 19-141-09 Dear �&. Butera: The request for tile waivers of the required 100 foot horizontal separation between and on-site wastewater disposal leachfield to a private well and an on-site wastewater disposal leachfield to the property line of less than the required 10 foot separation has been approved. The approved separation distances are the leachfield to the private well is 94 feet and the leachfield to the west property line is 5 feet. This waiver approval applies to the existing oil -site wastewater disposal separation, private well and west property line only. Any future upgrade to either will require all separation distances be met or another approval from this department. If there are any questions, please call our office at 343-4744. Sincerely, Daniel J. Roth Civil Engineer On-site Services DJR/Ijm:Larson Waiver A I Lor FN gLacIv �r1rYwir P.4,vt P.5rqrE5- K/,9/VF-fl 1?,c(?UErr NUNAFR 41Rfw10012 mflvRn flgPur-sr /,On ov-iar IvVY Aa OSanPrlall rl?t.evc" ar 911- 1�,vd Avoirenam FiE4.bl rO wcsr PI?Oftnry LivE or- S- � 5'Epr-,( PATh— TIV :�UOYE67- WtfX;r6LVnrC-f? ;�YfreAl WlJr COWS-MReArP IN NOV /W nif $EPARMIVAI OY ri-te rMrPeerlV6 AN61NOOR 1�,I;r /0,0 ' XT' Hitf �?Apov plrcovear-0 r-0 0 E ?'0 ', TUE OVEIT,11.1 SAOPE OF rHe 9ffq /.f PiC rYPIML APelyaR464 90P�l .1, F12om rmE cuumieli lsrNs ON-" P,#RP r0i-nROX rAfS /,vi-er (t4sr ro t-cs)) 1�141e# 1$ '96 APPROXIMAM4 Y -(' % 11 7 -HI -1 I)LWS*- reF- 1�18X7CLI-nTr-N XrXTOM I X POL-A, OreoplrNr (4val". FROM ME �vEi�l- (fifiv-), rme #8101?J-770� J -h -l-.0 IAI e?"aXr1&,v 1,5 rawrra"Crat2 64,00N,Sfy S*ivP)l rup wrii. IAI due-rrlalv /.f rl-ee Fivoc. rite v,.4 Ix ,;, rar/1-1. ,r- swlpep w)rH Agvulreq /)-r 4-9 "Er. r/'(E 015r(�66& 7 -He OSLPV Me FRavPoA(1,v,5*r4e L,�*y 9014e 6novet 9,�p fave X,9�12 AtIA,7 fr IS fqra ro fij�s",,tE rkogr rk45�rr L,,o'rAjl'x Atfe eomolmow6 ny& Powfislp ):Rom F C60Alr*MlA'&TlQlL, 00V ffilaWe irfremr J;�l 7744 6&0"�O Y"ier-�r& 0/y 6,vr prefee 9 A4 6 L1.9 jfv 6 r-a,,M riqe (,1yoUvV ;rc4ler&c-E. i�nrrn s4mpLss 1vv1c)prs mo cp4.,r-am,- lV19-crelvA ow v,rntqre;r pts)-x-c7'.q&V4E 1A, THee F"KNEN ju�P?meri�6 1A, /� yr-6af I-IV'f Ivor Afl6g*rev Pi5Lt L06,% 1,v T"k ARF4 AVOle,�r,- ru4r 7'He e'oNo-,,v1&6 41?,vCl?s ARe rov7-1,V1v44.% ri4K#u6a4o,4r rmE Amels. &L3o, Racillaal? /,r &;* rAea �r,+Uje *raQ0Arm,%J"r PRP7*11 PUTTIA,6 ir,3,r 9tv $-40pa. MAT A t� 1� ate C, 1). W, 4 -Y 4r )e =,/y !roll Lq OV 5- 7701v Y4- , , I � 'T 1 .1 m =.74* 2 25' Il 66fi,VO TOr,'�L 0 .3.2 2-3 2. el 2.8 2— MUNICIPAUly ()F ANChC*10*- eWIRQtAMEMTAL SERv ICES DIYISION APR 09 1996 Eagle River Engineering Services P'ECEIVED b3uis Butera, P.E. P.O. Box 773294 (907) 694-5195 tel Eagle River, AY\ 99577-3294 (907) 694-3297 fa, c CA - vL \ � -- r_'(1 April 3, 1996 Jim Cross, P.E. Murticipality of Anchorage On -Site Services P.O. Box 196650 Anchorage, AK 99519-6650 Re: Skyway Park Estates Lot 3A, Block I Dear Mr. Cross: On behalf of our client, Mr. Ed Larson, we are applying for determination of waiver of separation distance for the above referenced single family property. The requested waivers are for separation distance of 94' from private well to private leachfield, and a setback of the leachtield fi-om the west property line of less than 10'. The 5' separation to lot line was noted on the original septic inspection report, wl-iich would allow automatic approval. A site plan is attached. The well log for the subject property and for several nearby properties are attached. The subject well was drilled in 1971 to a depth of 58'. The original well log shows a layer of clay and gravel fi-om 23'-40' and again from 50'-57'. A layer of sandy clay is also found fi-om 40'-50'. Water was found at 57, with the well continuing on to a depth of 58', and a static water lever of 10'. This indicates a confined aquifer with several clay layers to provide protection fi-om surface contamination. The neighboring wells are consistent with the subject well, showing several layers of clay and hardpan material to aid in the protection of the aquifer, demonstrating continuity of the soil and aquifer conditions. Our well flow test, which was limited by the production rate of the pump, produced an average flow rate of 2.8 gallons per minute with a total drawdown of 9'fi-om static water level. The on-site sewage disposal inspection report was dated November 10, 1980. There were also two Health Authority Approvals issued, in 1981 and 1986. Water samples taken in 1986 showed satisfactory results. At that point the system was six years old, and is now 16 years old, and recent nitrate and coliform test results were satisfactory with no nitrate detected, which is a good indicator that the well is not impacted by this leachtield. GA%vpdacs\ I 996\95-114i-l(r c7— Z 60 7;Z' rK ? Z Near surface soil characteristics of the area are well documented. 'the inunediate subsurface soil is sandy gravel to well graded gravel (GW) to the typical test hole depth of twelve feet. Soils logs are attached for lots 6A, 613, and 3B block 4, to the South, and lot 2 block I to the North. Lots 1-4 of block 2 are undeveloped. Groundwater was not encountered on the neighboring lots listed above. There is no soil log on file for this lot, however, the inspection report shows an 85 soil type. The ground surface of the entire area has a slope draining to the west, and directly across Toy Drive the slope is 2-5% to the west. While the area between the septic system and the well on the subject lot is primarily flat, the well is on the uphill side of the general area's gradient. This would ensure that any surface and ground water would drain away from the water source, and that any possibly contaminate would also follow the gradientaway from the well. In regards to the setback of the leachfield from the lot line, the lots to the west are undeveloped, and Toy Drive is located between these lots and the existing leachfield of the subject property. The road provides a physical barrier between the leachfield and any future development, as does the 30'right of way to each side of the centerline of Toy Drive. This right of way will insure that any development to the west will have adequate separation distance to the existing leachfield by Municipality of Anchorage regulations. We believe that due to the physical characteristics of the lot and the small distance being wavered, there is little chance of a contamination problem. Please review the attached data and if you have any questions, Please call our office at 694-5195. Sincerely, " � ��,: ��5 ��- Matthew J. Nardini Engineering Technician Reviewed and Approved by, Louis Butera, P.E. G:\%vl)docs\1 996N95 -114a -[ti- g, . A., 0'r % -,; 3 , 0 l.k,;, A. ui�.ra 2;,5,F CC- , 1,730 �cl: WAWER S�TE PLAN LEGAL: SKYWAY PARK EST. LOT 3A, B[OCK 1— OWNER: LARSON CONTRACTOR: N/A JOB� 9 —114A I DATE: 04ZO2Z96 SCALE 1" = 40' KAULE RIVER ENGINEERING SERVICA'S AP.O. Box 773294 EAGLE RIVER, AK. 99577 (907) 694-5195 FAX: (907) 6,94-3297 Sl HULL NITOR TUBE SEWER CLEANOUT WELL EXISIING LEACHFIELD EASEMENJ OF :49T—H*' ........... . . . . . . . . . . . . . LOUIS A. BUTERA A E-673 I'A d,'� C 6 v kjkfqOFESSOtl-1�1�40 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 Application Date 28—F—A4LL�f q ) _q tl) 1. GENERAL INFORMATION (a) Legal D,escription (include lot, block, subdivision, Location (address or directions) f (b) Applicant Name 0-krll��Zyl Q Telephone: Horne Applicant Address J I Sl 0 -7-o AiookoraQ'(� _ _ .3 Business J.\r� -9 C7 T1 5- (c) Applicantis (checkoney Lending InstitutionD; Owner/builder NO*' Buyer 0 ; Other[] (explain); (d) Lending Institution Address (e) Real Estate Company and Agent Address __ Felephone M Mail the HAA to the followi address: Telephone 2. TYPE OF RESIDENCE Single -Family UK Multi -Family 0 Other Number of Bedrooms 3. WATER SUPPLY Individual Well ke CommunityEl Public 0 Note: It community wallsystern, must have wiitten confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite V Public 11 Community 0 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 I of 2 72-025 (1 1/B4) 5. ENGINEERING FIRM PROVIDINu INSPECTIONS, TESTS, FILE SEARCH, DAiA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of thi8N, Authority Approval shows that the on-site water Supply and/or wastewater disposal system is safe, functional and ad for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtam - from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/oNr wastewater disposal system is in compliance with all Municipal and State codes, ordinances. and regulations in effect on the date of this ins ection. . Name of Firm Nr(.kL��- Telephone Z/ -/ 9 C) Id. 11riA vr--a I-YK qqj-o�3 Address �3u_nk�e6 s -)Lw 131 Date ZP) FAY-LAcur� Lq-8-6— 'All % A—Frigineer's Seal CE -5233 /11 V.. 6. DHE15 APPROVAL Approved for bedrooms by _A_� Date Approved Disapproved --- Conditional Terms of Conditional Approval 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 engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DFIEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is riot responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAoE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) W 0 4 CHECKLIST - FEBRUARY 1984 264-4720 Legal Descri 1: WaR A. WELL DATA Well Classification JAI If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) URA Date Completed �0 -z Yield qp(yi I , I + Total Depth dc Depth of Grouting Rsed to J=== Static Water Level Pu m p Set At Casing Height Above Ground Sanitary Seal on Casing (Y/N) U f A Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) Ir N 0 Separation Distances from Well: I To Septic/Holding Tank on Lot /0 ;On Adjoining Lots _./00 — To Nearest Edge of Absorption Field on Lot . On Adjoining Lots i0o, 4 - To Nearest Public Sewer Line /00, + To Nearest Public Sewer Cleanout/Manhole —_ /00 + — To Nearest Sewer Service Line on Lot Water Sample Collected by (, - 040-C ; Date 1Z_ 2- 9 - 86 Water Sample Test Results — Comments _2�_Ofto�- B. SEPTIC/HOLDINGTANK DATA Date Installed /0 IVOV Size Z �aL No. of Compartments Standpipes (Y/N) —UjQ6-- — Air -tight Caps (Y/N) _126 Foundation Cleanout (Y/N) U-419 Depression over Tank (Y/N) 0 Date Last Pumped & ZO t1d A95 Pumping/Maintenance Contract on File (Y/N) tq /A ; for Holding Tank High -Water Alarm (Y/N) — N111C Temporary Holding Tank Permit (Y/N) NIA Separation Distances from Septic/H olding Tank: To Water -Supply Well — 16// — To Building Foundation To Property Line — 39 1 To Disposal Field To Water Main/Service Li Course Comments - W 00elo Pagel of2 72-026(il/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Design 4-"e I,, Date Installed 10 40 hAr Length of Field 5-1 Width of Field (0011 7r Depth of Field 2-1 4f -o -w 6410eq 10 Gravel Bed Thickness Z f Ile V V -P Square Feet of Absorption Area Z Standpipes Present (Y/N) y _e 6 Depression over Field (Y/N) A10 Date of Last Adequacy Test Z 2 r-_ 6, 0810 Results of Last Adequacy Test aLgt(04 4ar A�­-e-t Ldroom bo -U,51 Separation Distance from Absorption Field: To Water -Supply Well 11o, To Property Line /7' To Building Foundation To Existing or Abandoned System on Lot &/A On Adjoining Lots /00 4 - To Water Main/Service Line /oo To Cutbank (it present) NIA To Stream/Pond/Lake/or Major Drainage Course /Do , 4 - To Driveway, Parking Area, or Vehicle Storage Area 131 'i� Comments 7 CO ff CL�61 (.( 0-Y, P D. LIFTSTATION /A Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level at "Pump Off" Level at High Water Alarm Level at Vent (Y/N) Tested for Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments " Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, orconformed to all MOAand HAA guidelines in effect on the date of this inspection t&wa ��ac -zg Signed oe Date - C6 �tz � 0 - TVs Company kk All -L MOANo. 5 --?-1 � Receipt No. Date of Payment -S?. Engineer's Seal Amount: $ _/ Q'7 Page 2 of 2 72-026 (11/84) 5. LEGAL DESCRIPTION -�6+ k, -�TREET LOCATIX,, �� , I Sk4�(- fef RESIDENCE NUMBER OF,BEDROOMS 6. TYPE —=5 -- SINGLE FAMILY 0 One El Four 0 Other ED Two El Five 0 MULTIPLE FAMILY El Three El six 7. WATER SUPPLY INDIVIDUAL' ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY �det( ()rdted since June 1975. Foi wells drilled prior to that date, give well 0 PUBLIC UTILITY 11VS�' depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM ;iK INDIVIDUAL/ON-SITE** Iq SO YEAR ON-SITE SYSTEM WAS INSTALLED. El PUBLIC UTILITY NOTE: THE INSPECTION FEE MUSTACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-U I U f Rev. 6/79) i-� DATE RECEIVED INSPECTION APPOINTMENTS TI E TIME —TIME ('-i cl-q DATE DATE. DATE 0 A I i\11 sp5c-rOR INSPECTOR � TN -SP MUNICIPALITY OF ANCHORAGE A4UNI('IPAI.I-,y OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION DEPF- OF 11-�Al,i , 825 L Street - Anchorage, Alaska 99601 ENVIRONMENTAL Pj�uff-CTION ENVIRONMENTAL SANITATION DIVISION 0 (,1 f 2 0 1 ,;1 f. I Telephone 264-4720 REQUEST FOR APPROVAL E D OF INDIVIDUAL WATER AND SEWJWAEV DI RECTI DNS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY -R S'C'A 4a [V -r 'HONE MAILING A7'RESS PROPERI —PHONE 2. BUYER HONE MAILING A-DIDNESS 3. LENDING INSTITUTION A 6S L� t-6 -c &;/)K PHONE MAILING ADDRESS 4. REALTOR/AGENT 11 Nff— MAILING ADDRESS 5. LEGAL DESCRIPTION -�6+ k, -�TREET LOCATIX,, �� , I Sk4�(- fef RESIDENCE NUMBER OF,BEDROOMS 6. TYPE —=5 -- SINGLE FAMILY 0 One El Four 0 Other ED Two El Five 0 MULTIPLE FAMILY El Three El six 7. WATER SUPPLY INDIVIDUAL' ATTACH WELL LOG. A well log is required for all wells drilled COMMUNITY �det( ()rdted since June 1975. Foi wells drilled prior to that date, give well 0 PUBLIC UTILITY 11VS�' depth (attach log if available.) B. SEWAGE DISPOSAL SYSTEM ;iK INDIVIDUAL/ON-SITE** Iq SO YEAR ON-SITE SYSTEM WAS INSTALLED. El PUBLIC UTILITY NOTE: THE INSPECTION FEE MUSTACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-U I U f Rev. 6/79) i-� THIS SIDE FOR OFF;CIAL USE ONLY 1. TYPE OF RESIDENCE [__I SINGLE FAMILY ED MULTIPLE FAMILY NUMBER OF BEDROOMS E:1 ONE El THREE 0 FIVE ED OTHER E-1 TWO ED FOUR El SIX 2. WATER SUPPLY L1 INDIVIDUAL 0 COMMUNITY EJ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM DINDIVIDUAL/ON -SITE OPUBLIC UTILITY Connection Verified PERMIT NUMBER DATEINSTALLED INSTALLER E:]Septi ank or El Holding Tank Size. V " If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: SeptiClHolding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS El�"APPROVED FOR BEDROOMS El CONDITIONAL APPROVAL (letter must accompany certificate) F—I DISAPPROVED DATE J�_ BY i , ( 72-010 (Rev. 6/79) 5. LEGAL DESCRIPTION --2,& DATE RECEIVED INSPECTION APPOINTMENTS -)c TIME I _ME TIME E:I One El Four 0 Other W-- S G L E FAMILY 0 Two 1:1 Five DA NE—_ DATE DATE 3 9– 1ZI_--IrND1_TI DUAL* *ATTACH WELL LOG. A well log is required for all wells drilled INSPECTOR INSPECTOR TN­SPrCTOI V I,411.?IIr.IPAbIfY eF- MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION DEPARTMENT OF HEALTH 8, ENVIRONMENTAL PROTECTION —depth 0 WAS INSTALLED. 826 L Street - Anchorage, Alaska 99501 —YEAR ON-SITE SYSTEM ED PUBLIC UTILITY MAR 10 1981 ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complarteall partson page 1. Incomplete requestswill notbeprocossod. Pleaseallowten (10) days for processing. 1. PROPERTY OWNER PHONE 1:3Yq- ?tq( __&� MAILINGA�RESS (0 & (0-(t�t( , PHONE PROPERTY RESIDENT (If different from above) 2. BUYER PHONE MATL_1­NG —ADDRESS - 3. LENDING INSTITUTION TO—NE MAILING ADDRESS 4. REALTOR/AGENT HONE MAILINGADDRESS 5. LEGAL DESCRIPTION --2,& —?, STREET LOCATION -)c 6. OF RESIDENCE NUMBER FS� IIN E:I One El Four 0 Other W-- S G L E FAMILY 0 Two 1:1 Five El MULTIPLE FAMILY 0---ThTeM 0 Six 7. WATER SUPPLY 1ZI_--IrND1_TI DUAL* *ATTACH WELL LOG. A well log is required for all wells drilled 0 COMMUNITY since June 1975. For wells di illed prior to that date, give well I __I PUBLIC UTILITY lattach log if available.) B. SEWAGE DISPOSAL SYSTEM 'IND�VIDUAL/ON-SITE*' —depth 0 WAS INSTALLED. LP� —YEAR ON-SITE SYSTEM ED PUBLIC UTILITY )ECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE I 72-010 (Rev. 6/79) '"Ax 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE (D SINGLE FAMILY 0 MULTIPLEFAMILY NUMBER OF BEDROOMS 0 ONE 0 TWO ILD THREE 0 FIVE El OTHER E:I FOUR El SIX 2. WATER SUPPLY EJ INDIVIDUAL ED COMMUNITY 0 PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM DINDIVIDUAL/ON -SITE OPUBLIC UTILITY Connection Verified . PERMIT NUMBER DATEINSTALLED INSTALLER DSepticTaq�,cr El Holding Tank Size: I J, y � If Tank is homemade give dimensions: SOILS RATING TYPE or TANK MANUFACTU TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES WELLTO: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ftKZAPPROVED FOR BEDROOMS 0 CONDITIONAL APPROVAL (letter must accompany certificate) EJ DISAPPROVED DATE �-34 BY 72-010 (Rev. 6/79)