Loading...
HomeMy WebLinkAboutSKYWAY PARK ESTATES BLK 3 LT 6Skyway Par Estates Block 3 Lot 6 #019-141-24 Municipality of Anchorage ;. Development Services Department Building Safety Division On-Site Water and Wastewater Program. 4700 Bragaw St. P.O. Box 196650 Anchorage. AK 995198650 Page of www.d.andgrage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number. SWO60298 PID Number 019-141-24 William and Laura Walker Wastewater System: ❑ New ® Upgrade Aaamr 11901 Juniper Street Anchorage. AK 99515 ABSORPTION FIELD Pn 344-8214 reeaear a saaomer Five 17Deep Tirxm D s(aeoa T wcl DOW D Ma O Omar LEGAL DESCRIPTION Sal° T°�Oepv "'"WWW °'°° AS Ger Fl emk LIZ swowan Skyway Park Estates Dean b p9e m llwvt w l wiiM Gram apm praem we 3 Fl. 7 Tarnitw Rrge seaaal Fa a amw Or ilii Gr LaApm' 1-2 Fl. 120 Fl. Well: C3 New El Upgrade °" r e dr Dr w rwikr 3 F(. FL clremaaoon (faire. A a ct Tar DapmDara b Taut aawarxm ilia P"rawrl Existing F FL 1.680 Fe I ASTM D3034 PVC Direr Dau Dm SU Wow Lwal Yuuear Deu YUWsa A Plus Home Services 102-10/2006 Yeee Pu saal Cama Rwye Amro Grana TANK GPY FL FL SEPARATION DISTANCES 0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other. To Septic Absorption LM Holding ub(rJPlNate 1tlY1f lir Fnxn Tank Field Station Tank SererLxr Anchorage Tank 1.500 Ga Wal >100' >100' >100' WA >25 uar.r Steel 1Anaa a CanorYneru Two (2) s >100' >100' >100' WA LIFT STATION Lot Low >S >10' >5 WA 500 Gr Anchorage Tank Fa'•`0i10n >S >10* >5 WA 'Pu.v on' eerr at 41 •Pnp air Ierrl al 41 (ayi rw rim al 44 in m w Gunn onnNone Noted FU; ure a roar '14 Eranul impamar poo by Municipality of Anchorage R~i; Existing Septic Tank Was Pumped and Removed From the Site. BENCH MARK Lmamn � Deeaipm, Existing Absorption Field Abandoned in Place. Garage Slab 100.00 FL eQritii�r4� 1on/os Inspections performed by: A- Harela Dates: 11 10/M6 4Itjofa 2n4 10/6/06 a,�►��.AOF •Ac `�1� ' •q s •:?�. Development Services Department Approval * ,l, r ,y' Conditional Approval Date: lli:**"'• S.. _ ..... ... (1f� f> : LSQiAFI E ANCERSCN : "' " a-4331 Reviewed and approved by: Date: "0 40TESSt���i; 'a fid— �.�•�,1 ®�. ap to F ~O O J O N SL'SLZ 3 .00.00.00 N „ o6 lmrosn unun ,oL —�----------------------------------- � o FL I X' I I � I GoI I I I I ~ m l a �i 1~ o b Uig � i m J 1 I �� c N .•s•!` O 11 oO<`OH O H f W ULU p Zvo warn a; •. a C3 I� •. NN I� I Ao I I • I I I I I I I I SL•SLZ M .0£,L0.00 S . a: n n _ (WHO SINN30) 3Alaa LI3&Nnr m ti m o n'a g,rvn . rc m bHb2ab j •a � 0.•�•% a���` �I [L7 N i i 3 I�tY'.• �'. :� Z �• � Municipality of Anchorage Page 3 of 3 DEVEOPMENT SERVICES DEPARTMENT 4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904 Onsite Wastewater Disposal System or Well Inspection Report Permit Number. SWO60298 PID No. 019-141-24 98.7 Dreinfield Rock 60' (Trench Length) PROFILE AS -BUILT - Scale: 1'- td N i T-6-2006 05:32A FROM: 70:6777766 P:1/1 From ApplladMicrosystsen 17ad 04 Oct 2006 07 MIO PM ACT Pao. 1 or i MUNICIPALITY OF ANCHORAGE, BUILDING SAFETY DIVISION 47DO SOUTH BRAGAW INSPECTION INFORMATION 6 HELP: 343-7082 INSPECTION: VOICE 343,9300 INSPECTION. FAX (007)240-7777 www muri.orDtBSOltnspinaiuns dri NAME: EcraClact PERMIT*: 06-8164 COMPANY: INSPECT DATE: 10/5/2006 AN PHONE *: 272-4501 PHONE v: PHONE *: ADDRESS: 11901 PUMA S! LOT A BLOCK 3 SUBDIVISION: SKYWAY PARK ESTATES GRID *: SW2729 COMMENTS or DIRECTIONS Sea1c i;t station l call to Mee: TYPE OF INSPECTION: O:hcr Elrtrical COMMENTS: (FOR INSPECTOR USE ONLYI %o -X i PRINTED NAME •� ,,,,-._.-._..... .... OCT -5-2006 THU 05:46PM ID: DATE: PAGE:1 Description: LOT 3 30' N 90'00'00" W 299.87 --------------- — -- --- 5' UTILITY EASEMENT EXISTING GARAGE UFT STATION ,. �..:. sees::;. .,. •. •. ;. .7. sees •.. , ' •• , . ' GRAVEL DRIVE 174 a - .. OS Os AS -BUILT Lot 6, Block 3, Skyway Park Estates LAND do CONSTRUCTION SURVEYORS—P 440 West Benson Boulevard. Suite 200 Anchorage. Alaska 99503 Plat- P-632 Grid: 2729 Work Orden. 2006—L-153 R1 Fb/Pg: 67S LOT 7 NOTE: THIS DRAWNO IS Red Br Bill Walker Septic Standpipe (S Water wen p reit*—x—x— FOR USE AS A PLOT PLAN. SURVEY CERTIFICATION: his droll has conducted a physical survey of Ms property he Mown an this he pro and nes and that M* knm encs encs C21 other Merem ore rlMln Me property Ilrles end no *n000Mmen4 *del other Mon noted. EXCLUSIONARY NOTE It Is the owners' responsibility to determine the NERS—ENGINEERS exbbnce of any easements, coveonts, restrictions or right—of—way Phone: 562-5291 takings which do not opp*er on the recorded subdivision plat Under no chro mstonces Mould any data hereon be used for camUuction. Fax: 561-6626 for establishing property Imes, or for plot—pian purposes. Date NOVEMBER 16. 2006 Drown Sy. NRB -11 stole: I* -40' lChechod BY. AHP in n tri r- 04 W iA LOT 4 LOT 5 LOT 8 24.2 x - 3 I s , PLAY • ..• x x z W rr� HOUSE I I I Nm N Im I � Q P LIGHT rp Z m x—x� I w OElPOLE V. GREEN ❑ HOUSE ''*' 4 —x_X—x—x—x—x—xJ o SHED ''2%:. ' ® LOT 6 CURB I I 10' UTILITY EASEMENT 30' N 90'00'00" E 300.00' AS -BUILT Lot 6, Block 3, Skyway Park Estates LAND do CONSTRUCTION SURVEYORS—P 440 West Benson Boulevard. Suite 200 Anchorage. Alaska 99503 Plat- P-632 Grid: 2729 Work Orden. 2006—L-153 R1 Fb/Pg: 67S LOT 7 NOTE: THIS DRAWNO IS Red Br Bill Walker Septic Standpipe (S Water wen p reit*—x—x— FOR USE AS A PLOT PLAN. SURVEY CERTIFICATION: his droll has conducted a physical survey of Ms property he Mown an this he pro and nes and that M* knm encs encs C21 other Merem ore rlMln Me property Ilrles end no *n000Mmen4 *del other Mon noted. EXCLUSIONARY NOTE It Is the owners' responsibility to determine the NERS—ENGINEERS exbbnce of any easements, coveonts, restrictions or right—of—way Phone: 562-5291 takings which do not opp*er on the recorded subdivision plat Under no chro mstonces Mould any data hereon be used for camUuction. Fax: 561-6626 for establishing property Imes, or for plot—pian purposes. Date NOVEMBER 16. 2006 Drown Sy. NRB -11 stole: I* -40' lChechod BY. AHP in n tri r- 04 W iA LOT 4 LOT 5 LOT 8 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 11, 2006 Expiration Date: Sep 11, 2007 Permit Number: SWO60298 Parcel ID: 019-141-24 Legal Description: SKYWAY PARK ESTATES BLOCK 3 LOT 6 Design Engineer: 0014 ANDERSON ENGINEERING Site Address: 11901 JUNIPER STREET Owner Name: WILLIAM & LAURA WALKER Lot Size: 82725 SO. FT. Owner Address: 11901 JUNIPER STREET Total Bedrooms: 5 Permit Bedrooms: 5 ANCHORAGE. AK 99515- 1 This permit is for the construction of 0 Disposal Field [?) Septic Tank Holdin Tank vy ❑ 9 ❑ Pri ❑Private Well El 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 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. Received By: Date: Issued By! M__ Date: Municipality of Anchorage -�1 Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcell.D. 019-141-24 Property owner(s) William and Laura Walker Day phone 344-8124 Mailing address 11901 Juniper Street Anchorage, AK Zip Code 99515 Site address 11901 Juniper Street Anchorage, AK Zip Code 99515 I Legal description (Sub'd., Block & Lot) Lot 6, Block 3, Skyway Park Estates Subdivision Legal description (township, Range & Section) Lot Size 82,725 Sq. Ft. Number of Bedrooms Five (5) I THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN: Absorption Field Q Initial ❑ Septic Tank Upgrade ❑ Holding Tank ❑ Renewal ❑ Privy ❑ j Private Well ❑ Water Storage ❑ i 1 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/Rush Fees: Waiver Fees: c/ Date of Payment: d /R Date of Payment: Receipt Number. Receipt Number. (Rev. 11/05) Sep. B. 1006 10:17AM anderson engineering No. 2466 1 P. 1 MEMORANDUM DATE: September 8, 2006 TO: Joe Goodall FROM: Mike Anderson, P.E. SUBJECT: Lot 6, Block 3, Skyway Park Estates Revised Septic System Site Plan The new absorption trenches designed for construction on the subject lot are located 10' from the existing failed absorption bed. This separation distance is sufficient in this case as no effluent was detected in the test hole dug adjacent to the old system. In addition the trenches will be deeper than the bed providing additional separatioti; We are confident the existing failed bed will not influence the new absorption system and will eventually dry up to the point where it may be usable at some time in the future. Please review the attached documentation and advise if you have further questions ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 522-7773 677-7766 (FAX) MEMORANDUM DATE: August 30, 2006 TO: Joe Goodall FROM: Mike Anderson, P.E. SUBJECT: Lot 6, Block 3, Skyway Park Estates Revised Septic System Site Plan Attached is a revised Site Plan showing the location of the existing absorption bed on the property. We have also provided a more accurate location of the test hole. The new absorption trenches have been moved further east to provide sufficient separation from the existing absorption bed. A second test hole will be placed during construction of the new system to verify soil conditions on the property. A copy of the test hole results along with percolation information will be provided prior to completion of the new system. I Please review the attached documentation and advise if you have further questions ANDERSON ENGINEERING P.O. BOX 240773 ANCHORAGE, AK 99524 August 17, 2006 Municipality of Anchorage Development Services Department On -Site Water and Wastewater Program 4700 South Bragaw Street Anchorage, AK 99519-6650 Subject: Lot 6, Block 3, Skyway Park Estates Subdivision Septic System Design and Permit Application Impacts to Adjacent Properties Dear Onsite Services Engineer. The existing absorption system on the subject lot has failed and must be upgraded. We are therefore requesting a permit be issued for the upgrade of the septic system to accommodate the five -bedroom home on the lot. The attached Site Plan and backup documentation identify the location and configuration of the proposed septic system. The existing septic tank will be pumped, crushed and backfilled with sand.1 The absorption system will be abandoned in place. Also identified on the plans are the locations of the proposed well. No conflicts exist between the proposed septic system and the wells on this or adjacent lots. Drainage arrows are shown indicating the current drainage patterns. The drainage patterns will be maintained after construction. The test hole placed on the lot at the location of the new absorption trenches Ind Iicated silty gravel with some sand (GM). The percolation rate was determined to be 40 minutes per inch. We are proposing to construct a 1,500 gallon septic tank and 2-60' long by 3' wide absorption trench with 7' of gravel beneath the distribution pipe. The distribution pipe in the trenches will be placed at 4' below the surface with the total depth at 11'. No groundwater was encountered during placement of the test hole and none has developed over the past several months since the test hole was placed. The ground surface on the lot slopes slightly to the east in the area of the absorption trenches. The trenches will be placed parallel to the contours of the ground as much as possible and in conformance with design criteria. A minimum of 1 00'will be maintained between all components of the septic system and the proposed well and from any surface water in the area. i Lot 6, Block 3, Skyway Park Estates August 17, 2006 Page Two If the system is constructed in accordance with our design the following statements apply 2. 3. 4. 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. I 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. I 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. i 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, A f�"�'� p F— a(, Michael E. Anderson, P.E. Attachments 7:+,kL57 I V C�AEL E. AVEi SCV V No. CE -439' _ 0 CC W LL Z D I LOT 3 30' 10' UTIUTY EASEMENT N 90'00'00' E 300.0C LOT 7 i SITE PLAN SCALE 1"= 50' LOT 5 LOT 8 30' N 90.00'00' W 299.88- W UnUtt EASEMENT 2-"0•g x S. vAae x r E=. Depth ADsorpWn Trenches r—� w x — I I TM EXISnNC E -'b g m GARAGE Bed I 128.5 I Fbw Splicer j in , ' -GRA. EL DRIVE% " • Valw .> N 1728 1.500 Gallon n � Septic Tank 3 %:•`. F a N N 0 M HOUSE :'.,Fiw � O Beadrdr oom W O1 b UCHT, Home w , Z 0 PDLE Pump. Crush BarAsll 0 H ❑ Ensu EnsGrg k p i •.. GREEN 1 AoarM ADsorp astern D ❑ MOUSE I o b0 SHED Z x 0 LOT 6 j Ensung Well I i CURB 30' 10' UTIUTY EASEMENT N 90'00'00' E 300.0C LOT 7 i SITE PLAN SCALE 1"= 50' LOT 5 LOT 8 Ex'0 i I � ""°' 7 i! i 10 E,Z:q AREA MAP SCALE I"= VY D 8 • Exlllrg V"I 0 3 �� a QE VAS ------------------J L----------------I- ------------------ii------------------ I I ol 3 1 1 5 O O .- way I --- ----- --- - - t sE is A Z Ig Ex'0 i I � ""°' 7 i! i 10 E,Z:q AREA MAP SCALE I"= VY D 8 • Exlllrg V"I 0 LOT 6, BLOCK 3, SKYWAY PARK ESTATES SUBDIVISION DESIGN FACTORS: SYSTEM REQUIREMENTS: Five Bedroom Home Deep Trench System Perc. Rate: 40 Min./inch 1,500 Gallon Septic Tank Application Rate: .45 GPD/SF 7' Drainfield Rock 5 Bedrooms X 150 GPD/.45 GPD/SF (Application Rate) = 1,666.7 SF Absorption Area 1,666.7 SF/14 SF/LF = 119.05 LF Trench Length THEREFORE: Construct 2-60' Long x T Wide x T Effective Depth Aborption Trenches at the Location Shown. Flow Line Elevation in Trenches to be 4' Below Original Ground Surface. ITotal Depth to be 11' Below Existing Ground. Provide T of Cover Over Trench and 4' Over Tank or Provide 2" of Insulation and 2' of Cover. Place a Flow Splitter Valve to Assure Even Flow to Each Trench. Natural Backfill 3'6" Geotextile Fabric 6" 4" Perforated PVC (Holes Down) TO" 3' Drainfield Rock TYPICAL DEEP TRENCH SECTION (NO SCALE) NOTE: Grade Area Over Trench to Drain Away. Minimum 6' Separation From Bedrock. Minimum 4' Separation From Groundwater. Minimum 100' Separation From Private Wells in the Area. Minimum 100' Separation From Surface Water or Streams. Minimum 10' Separation From Water Service Line. MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT 4700 SOUTH BRAGAW STREET ANCHORAGE, AK 99519-6650 DEFT11 (feel) I- 2 3 4 6 7 9 10 11 12 13 14 15 16 SOILS LOG - PERCOLATION TEST .- LEGAL DESCRIPTION: LOT 6, BLOCK 3, SKYWAY PARK ESTATES SUBDIVISION PERFORMED FOR: BILL WALKER DATE: 3/8/2006 PROJECT No.: PARCEL ID#: TECIINICIAN: MEA °nf TEST HOLE # 1 f77-� OB/OG SLOPE SITF FI AN SILTY GRAVEL W/SAND GM 1 1 I READING GROSS TIME (MINUTES) ------------I I TH I I I DATER (INCHES) s 8/1/06 � I 1 -------� ---J 3.75' WAS GROUND WATER ENCOUNTERED? No I IF YES Q WIIAT DEFnr DEPIII OF WATER AFTER MONROMING: NME I% DATEOFMONITORING: Ril/On DATE READING GROSS TIME (MINUTES) NET TIME (MINUTES) DATER (INCHES) NFT DROP (INCHES 8/1/06 TEST HOLE PRESOAKED PRIOR TO TESTING: 1 14:23 3.75' 2 14:53 30 41.56' 0.81- 3 14:58 3.81' 4 15:28 30 4'.56' 0.75' 5 15:29 3.75' 6 15:59 30 4'.5' 0.75' PERCOLATION RATE; (MIN/INCII) PERC. HOLE DIA. 8 (INCHES) TEST RUN BETWEEN: 4.5 FT. and 5.5 FT. COMMENTS: TEST HOLE PRE SOAKED PRIOR TO TEST. I TEST PERFORMED BY VETECII ENGINEERING TECHNICAL SERVICE. 1, MICHAEL E. ANDERSON CERTIFY THAT THIS WAS PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPLE GUIDELINES IN EFFECT ON THIS DATE- ON-SITE WASTEWATER DISPOSAL SYSTEM CONSTRUCTION AND MATERIAL SPECIFICATIONS SUBJECT: LOT 6, BLOCK 3, SKYWAY PARK ESTATES SUBDIVISION GENERAL: 2. 3. 4. 5. The scope of this project includes the procurement and placement of a new 1,500 -gallon septic tank at the location shown on the Site Plan. Work also includes the construction of 2 new 60' long X 3' wide X 7' effective depth absorption trenches at the location also shown on the Site Plan! The distribution line in the trenches will be placed at 4' below the existing ground surface. Total depth of the trenches will be 11' below the existing ground surface. The new absorption trenches and septic tank must be placed a minimum of 100' from all private wells and any surface water in the area and 10' from the water service line proposed for the lot. A minimum of 3' of cover is required over the absorption trench and 4' of cover over the septic tank. A flow splitter valve must be placed to insure even flow from each trench. The existing septic tank must be pumped, crushed and abandoned on 'site or removed from the property. The existing absorption system will be abandoned in place. Construction shall be in accordance with the approved site plan, design drawings, Municipal Permit with any special provisions or conditions, and all applicable State and Municipal Wastewater Disposal Regulations. The Contractor shall be responsible for obtaining all underground utility locates and for the layout of the septic system and verification of the location of all lot lines. The Contractor must also verify the location of wells' in the area and assure that the separation distances are met. Unless specifically agreed otherwise, the contractor shall be responsible for final grading areas subsequently depressed from soil settling. Property owner shall be responsible for revegetation of affected areas unless specifically agreed otherwise. Contractors installing wastewater disposal systems must be certified by the Municipal Department of Health and Human Services for system installations. Owners installing their own systems must receive prior approval from D.H.H.S. before beginning system installation. I SEPTIC TANK INSTALLATION 1. A new 1,500 -gallon septic tank must be procured from an approved source and installed at the location shown. I Lot 6, Block 3, Skyway Park Estates August 17, 2006 Page 2 of 3 2. 3. 4 5. 91 7 A septic tank is to be constructed by a certified septic tank manufacturer. Construction shall include two 4" cleanouts for pumping access. The septic tank shall be sufficiently bedded to prevent settling or shifting of the tank. All standpipes on the septic tank shall extend a minimum of 12 inches above final grade. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial insulation. A foundation cleanout shall be installed one to four feet from the building foundation. Two cleanouts are required between the tank and the drai6field. Final grading over the tank shall be such that a positive slope exists away from the septic tank. DRAINFIELD CONSTRUCTION: 1. The drainfield shall be constructed to the dimensions shown on the design. The bottom of the trench shall be within 2" of level. I 2. Distribution piping must be placed level with perforations down atop a level bed of drainfield rock. Rock should then be placed over the pipe to provide a minimum of 2" of cover. 3. A silt barrier or geotextile fabric must be placed between the drainfield rock and the natural soil backfill. 4. Monitor tubes must be 4" in diameter and installed at the locations shown on the design. The portion below ground must be perforated. 5. Contractor shall verify the septic tank and drainfield are a minimum 100' away from any private water wells in the area, 150' from a Class "C" Well or 200' from any community well. 6. Direct bury insulation must be placed over the distribution system if less than 3' of backfill depth is available. Finish grade over the trench must be mounded to prevent settlement or depressions. 7. Grade area surrounding the absorption trench to drain away. 8. A minimum 2' of accepting soil is required below the drainfield rock for a 5' wide trench. Contractor shall verify this condition prior to placementlof the rock. All pockets of unacceptable materials must be removed and replaced. Lot 6, Block 3, Skyway Park Estates August 17, 2006 Page 3 of 3 MATERIAL SPECIFICATIONS: 1. Septic tanks must be constructed by a municipally approved septic tank manufacturer. 2. The following pipe materials are approved for use in septic system installations in the Municipality of Anchorage: Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM'D2662 or A.B.S. (perforated and solid). 3. Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow Chemical Co. Styrofoam HI or equal). 4. Septic tank inlets and outlets shall be fitted with watertight couplings (Caulder, Femco, or equal). 5. A permeable geotextile fabric (Typar, Mirafi or equal) must be installed between the final drain rock layer and the native soil layer. 6. All drain rock shall be .5" to 2.5" in diameter with less than 39/o passing the #200 sieve. INSPECTIONS: Municipal Ordinance requires a minimum of two inspections. These inspections must be conducted under the supervision of a professional engineer registered in the State of Alaska. The first inspection must be conducted after the excavation of trenches, beds or pits and before the installation of any gravel. A septic tank may be set in place, but may not be backfilled. The second inspection must be conducted after the placement of the geotextile fabric, gravel, distribution piping, standpipes, cleanouts and insulatiori. No backfill should be in place at the time of inspection. Contractor shall provide a copy of all field survey layout and construction notes for use in preparing the certified as -built of the completed system. 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 / '—� —�� G PHONE 1-1 NEW �Y=�fIq%- AUPCRADE a� �O dC C�-•% ;?S U�'1 _.___ MAI LING ADDRESS 1SS�'�� [[ — 0 A �y�y 7V� x-11— L _ LEGAL DESCRIPTION LOCATION sWe-et / NO. OF BE)gOOMS I- Z Well Absorption area Dwelling DISTANCE TO: Manufacturer Material PERMIT NO, r yQ., . No. of compartments aQ WE - w Liq, capacity in gallons Inside length Width FIOMEMADE: Liquid depth IF Well Dwelling PERMIT NO. JUZ DISTANCE TO: — <� Z h Manufacturer Material Liquid capacity in gallons O Well Foundation Nearest lot Zine PERMIT NO. -az w DISTANCE TO: Lu u z -- z No. of lines Length of Qacch/line Total length of lines Trench width inches Distance between lines 6, w H / p _ _ _ _______-_ Top of rile to finish —grade- Material beneath rile p Total effective abs�o/rp�tion area v 'a-_/ p inches "7 Length Width Depth PERMIT NO. w Q F Type of crib Crib diameter Crib depth Total effective absorption area 4 - ul w w DISTANCE TO: Well Building foundation Nearest lot line J Class Depth Driller Distance to lot line PERMIT NO. w � DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) OTHER — — W If 'S PIPE MATERIALS /7,- 1111? -.Y Y7,- • e SOI L TEST RATING YG7/iS2 }fie /�xre. %si_ �• �ercl INSTALLER, REMARKS —LJPSr,� Ch-- l- ,/., 7r't y da 5 5t, APPROVED DATE LEGAL S -- 72-013 (Rev. 3178) THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: � illEFF"vow- z'.� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET) THERE 15 NO SET WIDTH FOR TRENCHES, THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). Fe EE, k -H *1: F;�" CH: �1- 1 ol-; �q-,q pr:-, ��F" —, �r:'*-".o Cl ������0.'; PERMIT APPLICANT 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. _~� ��� ��� ������������ ��� ������ �~_ BACKFILLING OF ANY 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 H PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARF.. AVAILABLE TO INSURE PROPER INSTALLATION. ��Q1.1 X , 0 1r: ���EE: ���F� ��� lava fEn 1L I CERTIFY THAI 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: � . _-___..._-___^.~____.._^_'- ~^~~------- - X. APPLICANT HAROLDVERGHS0N A v/�� u �~~— ^ PIR -314i 1: H0 1 1: 1-91 K13 107 ����R? 101 E.", DEPARTMENT i HEALTH AND ENVIRONMENTAL OTECTIO ^ 825 /L/ STREET/ ANCHORAGE, AK. 99501 ( /\r ' 284_4720 -----~- ][-1-EE n5 EE 04 FE FR PERMIT NO ( O11085 ) � /1 // ( .( - APPLICANT HAROLD VERGHSON [��(��<Y}9/CY- BOX 4-1880 99509 344~2997 J` LOCATION WOO BOULEVARD � LEGHL L 6 B ] SKYWAY PARK EST. LOT SIZE 90000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRENCH MHXIMUM NUMBER OF BEDROOMS - 4 SOIL RATING (SQ FT/BR)- 155 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: � illEFF"vow- z'.� THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRHINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANCE BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE EXCAVATION (IN FEET) THERE 15 NO SET WIDTH FOR TRENCHES, THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL PIPE AND THE BOTTOM OF THE EXCAVATION (IN FEET). Fe EE, k -H *1: F;�" CH: �1- 1 ol-; �q-,q pr:-, ��F" —, �r:'*-".o Cl ������0.'; PERMIT APPLICANT 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. _~� ��� ��� ������������ ��� ������ �~_ BACKFILLING OF ANY 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 H PRIVATE WELL TO R PRIVATE SEWER LINE IS 25 FEET AND TO H COMMUNITY SEWER LINE IS 75 FEET. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARF.. AVAILABLE TO INSURE PROPER INSTALLATION. ��Q1.1 X , 0 1r: ���EE: ���F� ��� lava fEn 1L I CERTIFY THAI 1: I HM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. ]: I UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 4 BEDROOMS. SIGNED: � . _-___..._-___^.~____.._^_'- ~^~~------- - X. APPLICANT HAROLDVERGHS0N A v/�� u �~~— Y Department ^UHealthLand environmental rotection 825 L Street, Anchorage, AK. 99501 264-4720 jJ ar at HANDWRITTEN PERMIT aE # WR -ON-SITE SEWER PERMIT / ' Mailing Address: cs' gd Applicant: o✓ CLQ V/J�_ g Location:foo �C�c��1 II�� Phone Number; -�G _ �f�" Legal Description: �^ �Lo �SK ;��i Lot Size: Qo d Type of Soil Absorption System Is: Trench: L/ Drainfield: _ Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating(sq.ft/br) /.S,s The Required Size of the Soil Absorption System Is: I i I DEPTH Cl', >S LENGTH _. GRAVEL DEPTH —_ WIDTH The length dimension is the ength(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). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE = t c vv�GALLONS # Permit applicant 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. * * * TWO(2) INSPECTIONS ARE REQUIRED aA # Backfilling 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 is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 3 1 " * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will instal]. the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement the resi ?nce 's remodeled to include more that r,3 b, rooms. Signed Issued by: S�)t((�r+/,! sh—�— Applican { Date: IO 'V^O'1 SWP/02.4 (1/81) if 6AAB HO .GRP ER ANCHORAGE AREA BOROLI( DEPARTMENT OF ENVIRONMENTAL QUALITr 3500 TUDOR 110AD ANCHORAGE, ALASKA 99507 279-8686 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM MAILING NAME ,�%%-/�fijG ---__ ADDRESS-.%L....�rJ�%/-(/r'y% —PHONE:-1%:''•i� _/`� /i1� LOCATIONiiC'r' /_i-/- /}✓l"� LEGAL DESCRIPTION �' _ __ _ �r�_ SEPTIC TANK: / _ NUMBER OF DISTANCE FROM WELL .j h —MATERIAL -S7 /3�7 _. COMPARTMENTS_ '— ,S�%GYG. .Sf.C% /lL..1 ✓%%tai°/ LIQUID LIQUID CAPACITY__Z�j Gam__.__ -GALLONS. INSIDE: LENGTH _INSIDE WIDTH DEPTH SEEPAGE SYSTEM: SEEPAGE PIT: , NUMBER OF PIOUTSIDE DIAMETER —OR WIDTH_. LENGTH--, DEPTH X LINING MATERIAL S�%[�C%' DISTANCE FROM WELL,4�2-'='T��• �"'�G .BUILDING FOUNDATION i NEAREST LOT LINE TOTAL TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA)__ �_� _ SQ. FT. TILE DRAIN FIELD:///' DISTANCE FROM NUMBER OF LINES AREA DEPTH: TOP OF TILE TO FINISH GRADE TOTAL LENGTH FOUNDATION , NEAREST LOT LINE_ -, OF LINES_ , INCE BETWEEN LINES- TRENCH WIDTH IN. TOTAL EFFECTIVE SQ, FT. LENGTH OF EACH LINE --�/ - OF FILTER MATERIAL BENEATH ABOVE TILE WELL: ell_Ii fK ///'/.'?.Y�,Y, DISTANCE FROM c WATER DEPTH_ -/'c> _,BUILDING FOUNDATION.__�1 —_SAMPLE��//-5 NEAREST NEAREST SEPTIC SEEPAGE OTHER / I —_ � _ LOT LINE —L'�ul ,SEWER LINE�L �—, TANK- ?L _, SYSTEM— ��'r/� CESSPOOL��f, SOURCEY_L��llr'k' DISTANCES: LSO DATE DIAGRAM OF SYSTEM 1. p Ll Nil/�• cp�Vrr?tacljS✓ T✓. i 1 GREATER ANCHORAGE AREA BORUUGH DEPARTMENT OF ENVIRONMENTAL QUALITY PERMIT NO. GOA 3500 TUDOR ROAD POUCH 6"650 ANCHORAGE. ALASKA 99502 / TELEPHONE 279"6686 SEWAGE DISPOSAL SYSTEM — APPLICATION AND PERMIT NAME OF APPLICANT G'G'f7 "'" MAILING ADDRESS�- INSTALLATION LOCATION LEGAL DESCRIPTION — / INSTALLATION OF: SEPTIC TANK SEEPAGE PIT — —, /DRAIN FIELD —. OTHER , TYPE AND SIZE OF FACILITY TO BE SERVED FINANCED THROUGH TO BE INSTALLED BY SOIL TEST RESULTS — NOTE: THIS PERMIT IS NOT VALID WITHOUT SOIL TEST r_ COMPLETION DATE ANTICIPATED z FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE HEALTH ]DEPARTMENT AUTHORITY WILL BE SUBJECT TO PROSECUTION. !— c�[ SEEPAGE AREA SIZE ��lf���� TVPE 6�f- SEPTIC TANK SIZE TYPE MINIMUM DISTANCES, REQUIREMENTS FOUNDATION TO SEPTIC TANK FOUNDATION TO SEEPAGE PIT �DRAIN FIELD SEPTIC TANK TO SEEPAGE PIT WALL SEPTIC TANK � SEEPAGE PIT �—, DRAIN FIELD TO NEAREST LOT LINE. WELL TO SEPTIC TANK DRAIN FIELD SEEPAGE PIT ALSO CONSIDER AREA WELLS. WATER MAIN TO SEPTIC TANK SEEPAGE PIT m: AlemalAR-1 SEPTIC TANK,": / . SEEPAGE PIT �C G-� DRAIN FIELD TO RIVER, LAKE, STREAM, CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO CRIB CROSSING GAP OF EXCAVATION 5 FEET INTO UNDISTURBED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FITTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARDING INSTALLATION. 1 L � HEALTH AUTHORITY OR LICENSED DESIGNER DIAGRAM OF SYSTEM 1 CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER ANCHORAGE AREA BOROUGH ORDINANCE NO. 28-68 AND THAT THE ABOVE DESCRIBED SYSTEM IS IN ACCORDANCE WITH SAID CODE. I,/ 7 DATE APPLICANT'S SIGNAT R&M ENGINEERING 8, GEOLOGIC, .. CONSULTANTS 946 COWLES, ROOM 102 — P. 0. BOX 2630 — FAIRBANKS, ALASKA 99701 6 1 TELEPHONE 907-452-1655 Civil vi! Engineers Geologists Land Surveyors JAMES W. ROONEY, P. E. RALPI I R. MIGLIACCIO MALCOLM A. MENZIES, P.E., L.S. Engineering Geologist JAMES H. WELLMAN, P.E. July 5, 1972 R & M No. 26540-2 Gorder Excavating 7929 Lake Otis Parkway Anchorage, Alaska RE: Test Hole and Soil Log Report for Sanitary System Lot 6, Block 3, Skyway Park Subdivision Dear Mr. Gorder: We are submitting herewith the test boring results and our comments regarding soil conditions encountered at the subject site. This investigation was performed , in accordance with your request of June 30, 1972, and those procedures outlined in a letter dated September 13, 1971 by Mr. Rolf Strickland of the Greater Anchorage Area Borough Department of Environmental Quality. A single test hole was put down within the Lot 6 area for the purpose of defining general subsurface soil conditions for the proposed sanitary system. Excavation was accomplished with a tractor -mounted backhoe and the test hole was extended to a total depth of 13. 5 feet below ground surface. The final log prepared for the test hole has been included in Drawing A-01. Ground water was not encountered in the test hole. We appreciate being given this opportunity to be of service to you. Should you have any questions with regard to the above, please do not hesitate to contact us. Very truly yours, R & M ENGINE/E�RRIIING & GEOLOGICAL CONSULTANTS j/' RECEIVED' James W. Rooney JUL •t 1971 ?M s JWR:wb Enclosure • Gpffl, Of N VIBONMERAGE NTAL Ounnly BOROUGHEA cc: Greater Anchorage Area Borough TTAIrlDiJ 6 Am-T �umllllnl VV (DmLm :I 1209 AfUl(OM St. 99515 AN cHonAGE, ALAsxiA 644-7714 SIX INCH WATER WELL DRILLED ........... OUT TO THE DEPTH OF _ geet. -- DRILLED AT THE RATE OF -'------ -"- PER FOOT. PROPERTY OWNER Ike liataid UeAga4on LOCATION OF WELL SITE as 6 Bik. 3 SL&lj. Skyway, %alk. DRILLER BeVUe C.lau4 G� lampcVrt ti2UUAg bJG ka. WELL LOG: 0----16' S. tbj. 4an4 wet gA avet. 35% 16---34' kwwadpan. R cemented Vmve - 34---55' Tine 4and going .auto a coauC 4an.d & f -tae guwei at 52 lee.t. 52 to 55 f-eet 4howw a good c{.eam water beahin.g f -tae gtaueC p&oductW SgPfll. Oateh ,cecoveuy back up to wtGthta 28 .deet 4 .the 4mace. S-teet. ca4taq, d)ttven .to .the 4�J t de2th o4 53 A. MUNICIPALITY OF ANCHORAGE C DEPT. OF HEALTH & pNVIRONMENTAL PROTECTION A JUN 319Hn RECEIVED COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF "--- THANK YOU VERY MUCH. BERNIE CLAUS OF RAMPART DRILLING WORKS DATE IRatp 9th. 9972 _ ` �-� �. c-J`-4Lko'kh - SERVICE CHARGEOF IV,% PER MONTH WILL BE ASSESSED ON PAST DUEACCOUNTS. Municipality of Anchorage Development Services Department Building Safety Division Onsite Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsfte (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 019.141-24 1. GENERAL INFORMATION Complete legal description COSA# Oq 0?36 Expiration Date: ! — oZ /".1 (O Lot 6, Block 3, Skyway Park Estates Subdivision Location (site address) 11901 Puma Street Anchorage, AK 99515 Current Property owner(S) Mark r. Mantyre Day phone Mailing address 36254 Spur Highway SoIdotna, AK 99669 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address Unless otherwise requested. COSA will be held by DSO for pickup. 2. NUMBER OF BEDROOMS: Five (5) 3. TYPE OF WATER SUPPLY: Individual Well Individual Water Storage . . Community Class Well Public Water System The -Municipality of. Anchorage Development Services Department (DSD) issues Certificates of.OnSfte 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 OnSfte 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. TYPE OF WASTEWATER DISPOSAL: 21 Individual On-site ❑ Individual Holding Tank ❑ ❑ Community On-site ❑ ❑ Public Sewer ❑ The -Municipality of. Anchorage Development Services Department (DSD) issues Certificates of.OnSfte 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 OnSfte 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 affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of Onsite 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 Finn Anderson Engineering Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. 6. DSD SIGNATURE Approved for ;7' bedrooms. Disapproved. Phone 522-7773 Date . , G-- 10192009 Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By: l(J • Original Certificate Date: (R« 11M) Municipality of Anchorage ' Development Services Department Building Safety Division Onsite Water & Wastewater Program • • •t• 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-79D4 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST Legal Description: _.Lot 6, Block 3, Skyway Park Estates Subdivision - Parcel ID: 019.141-24 A. WELL DATA Well type Private Date completed W72 Total depth 55 ft. Date of test Static water level Well production If A. B, or provide PWSID #_ Sanitary seal (Y/N) 1Y Cased to 55 R FROM WELL LOG 519!72 LINK a ft. Well Log (Y/N) Y Wires properly protected (YM)y Casing height (above ground) >24 in. AT INSPECTION 10!7/2009 33.2 ft. 2.7 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 mL Nitrate •639 mg/L Other bacteria 0 colonies/100 mL Arsenic N/D mgA Date of sample: 923109 Collected by: M• Anderson B. SEPTICIHOLDING TANK DATA Tank Type/Matedat Septic/steel Date installed 1072-1012006 Tank size 1.500 gal. Number of Compartments Two Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (YIN) N High water alarm (YM) Y Date of pumping 10/8/2009 Pumper Denali Pumping C. ABSORPTION FIELD DATA Date Installed 10/012006 Soil rating (g.p.dJftr orft2/bdnn) A5 GPDisF System type Deep Trench " Length 1120 g Width 3 L A. .Gravel below pipe :7 ft. .Total depth:;:; I Eff. absorption area 1.680 ft . Monitoring tube Y Depression over field N Date of adequacy test 10,7109 Results (Pass/Fail) Pass For 5 bedrooms Fluid depth in absorption field before test 110 In. Water added 7fi2 gal. 1New depth 2.5/1.5 in. Elapsed Time: 120 ' min. Final fluid depth 110 in. Absorption rate .>= 7W g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed 1011012006 Size In gallons Soo Manhole/Access (Y/N) Y 'Pump on' level at 41 in. 'Pump off" level at41 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• Absorption field on lot >100' Public sewer main N/A On adjacent lots >1006 On adjacent lots >100• Public sewer manhole/cleanout N/A Sewer/septic service line >29 Holding tank N/A Animal containment areas None Manure/animal excrete storage areas None SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation >5' Property line L5' Water main N/A Wells on adjacent lots >too' Absorption field >5' Water service line >10' Surface water >100' SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >10' Building foundation >10' Water main >ta Water Service line 1,10' Surface water >100' Driveway, parking/vehicle storage >29 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 10/8/2009 COSA Fee $ 11 q0 Date of Payment Receipt Number (Rev. 11/05) Waiver Fee $ Date of Payment Receipt Number ,; 1 /.o ¥ ( § CL ui S k k 3 L) / §OL x I A ) J E {\) LD u / ƒtet0.( k � 'a .S��p f CL L) � } k § ( { 2 \§§ E « C,41-1 k _ E co ° k m \ \ m Lj § § /S■ f b \ §2� 9eaG � (� w< �\ k § co §( ? 0 A k k E {\) LD u ƒtet0.( k 076 L) 'a .S��p CL L) � } k ( \§§ E k E /�~ n /S■ f o 9eaG /LU f/ea � � e C)Go £ ) ( mm C% cncn §$I$k f� < (\/k» f� < Cq �&|k000000000A�� ${ <000000�o »;m �� . (\i/ »^Lq [2 \ <00000 000«»m [ #iii$■SS2222S228 77 <0,000000000 V k/£§§§§�)§§§§ ) )2\ �mSaCM1 M'w C4 )/ ] ik in tn 0 (D amI- coIc § 2 ~ 4um2f4\2\\R 22{ §a#a7§§a§§§a ( q===2 p A k k ƒ ( {\) LD u ƒtet0.( k 076 L) 'a .S��p CL L) � } A R {\) °«3 \§§ /�~ /S■ 9eaG f/ea R Municipality of Anchorage Development Services Department Building Safety Division On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 9951916650 www.muni.org/onsde (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 019-141-24 COSA# n M4�- Expiration Date: 10 — 13 — O.% 1. GENERAL INFORMATION Complete legal description Lot s, Bkxk 3, Skyway Parc Estates Subdivision Location (site address) 1190 treat Anchorage, AK 99515 Current Property owner(s) William and Laura walker Day phone 344-0124 11901 Street Anchorage, AK 99515 Mailing address - VtqtqMLj 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: Five (5) 3. 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 ❑ 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 Onsite Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-famity on-sfte wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site 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 affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of Onsite 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 Phone 522-7773 Address P.O. Box 240773 Anchorage, AK 99524 Engineer's Printed Name Michael E. Anderson, P.E. Date 7nI12oo7 a MCHACL G NDS , - --.- - .-... 5. DSD SIGNATURE _JZ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By04 U Original Certificate Date: (R.. mrus) Municipality of Anchorage •. Development Services Department Summ Safety Division OnSke Water 6 Wastewater Program 4700 SrsgaW Street P.O. Sox 196650 Anchorage, AK 995196650 www.munLorglonske (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST LMW Dt n: Lot 0. Bb& 3. E!gTn Park Estaes ammM.tm Parcel ID: 019.741-24 A. WELL DATA Wen type PrN t- If A, S, or C provide PWSID #_ Wall Log (YIN) Y Data completed 5072 Sanitary seal (Y" Y Wles property protected (YIN)y - --- TOt8HIOPt r is -- -IL---- - --- Casa I toss' - - IL- - Casing height (above ground) 22t - ---in.- -- - . _ .. ... FROM WELL LOG Data of lest 51sn2 Static water level LINK fL Wen production s 9 - p.m -WATER SAMPLE RESULTS: Co ftm 0 a0lonlesMW mL Nitrate 2A7 Mg& Arsenic: NO mgA Date of sample: MT S. SEPTIMOLDING TANK DATA Tank TypelMaterlal 8a0rbBtear Tank sae 'Am gal. Number of Congmtrim, ft TWO AT INSPECTION 11µ4e 3z1 it 7.49 9 - p.m - Other bacteria 0 coloniesmoo mL Collected by: F. LOW= Date installed 180-MM06 Cleanouts(YIN) Y Foundation deariout (YIN) Y Depression over tank (Y" N High water alarm (VIN) Y Date of pUMpin9 No* COMOu`lan Pumper C. ABSORPTION FIELD DATA Date Installed 101a AN Son rating (g.p.d.Atr or ft!1bdmt) •4s caPDW System type Dip Twich Length 110 R Width 3 R Gravel below pipe 7 R Total depth • a' 0 fL Effabsorption a=J&W_ 0 ft° MOnnorfrp tube Y Depression over field N Date of adequacy test Now WOL Results (Pass/Fall) For _ bedrooms Fluid depth in absorption field before test irL Water added gal. Now depth in. Elapsed Time: min. Final fluid depth in. Absorption rate x g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN tL type) If yea. give date iD. LIFT STATION Date installed lanaaom Size in as&= Sao 'Pum on' level at41 in. -Pump oft' level at 41 in. Datum 9oeae of Tutt Cycles lasted New Cautrucdon E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAift station on lot >1W Absorption field on lot >1ao• Public sewer Train WA Sewer /septic service lira >25' ManholatAocess (YIN) Y High water alarm level at 44 Meets atarm a twit Mquiamenft9 On adjacent kft >latr On adjacent lata >1W Public sewer menhole/deanout WA Holding tank WA Animal containment areas Nab Manure/animal excrete storage areas Nab SEPARATION DISTANCES FROM SEPTIGHOLDING TANK ON LOT TO: Building foundation >s' Property lira >& Water main WA Absorption field >6 Water service line >10' Surface water >1an Wells on adjacent Iota >1W SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line >14Y Building foundation >19 Water main >1a Water Service line >11Y Surface water >1W Driveway. chide Nome >26 Curtain drain Nab Noted Wells on adjacent bb >1W F. COMMENTS: G. ENGINEER'S CERTIFICATION y`p4 74 review M that I have determined itrough field inspections and 49th unx*d records Brat the above systems are in conforrrance WIM MOA COSA guidelines in effect on this date. manta L Aram M Engineers Printed Name Michael E. Anderson, P.E. i4m CE -4= Data 7n1/2o07 ` 7/ •c r�rv..raRm{�� COSI► Fee S56 Data 5U Data of Payment T/ l 1,Q7 LLI Receipt Number. `7 �I TW (Rev. 111057 Waiver Fee $ Date of Payment Receipt Number Y in. SCS RaEN 1073087001 All Dates/Times arc Alaska Standard Time Client Name Mike N. Anderson, P.E. Printed Date/Time 07/11/2007 10:24 Project Name/# Anderson Engineering Collected Datefrime 06/29/2007 10:59 Client Sample ID 11901 Puma Street Received Date/Time 06/292007 11:07 Matrix Drinking Water Technical Director Stephen C. Ede PWSID 0 (<250) 07/03/07 07/03/07 Sample Remarks: 4500-NO3 - Total Nitrate/Nitrite - The matrix spike recovered below the QC criteria. The batch LCS is within QC limits. 300.0 - Anions - The matrix spike recovered outside of acceptance criteria for chloride because the spike was double. See LCS for QC requirements. Allowable Prep Analysis Paramna Results PQL Units Medved ConumerlD Limits Date Date Init Waters Department Total Nivatc/Nitritc-N Private Individual Analvais Fluoride Chloride Sulfak: Total Dissolved Solids IIC03 Alkalinity CO3 Alkalinity OI I Alkalinity Conductivity pit Alkalinity Total Coliform 2.47 0.100 mg/L SM20450ONO3-F D (<10) 07/03/07 JDS ND 0.100 mg/L EPA 300.0 D (Q) 07/03/07 07/03/07 JDS 58.6 1.00 mg/L EPA 300.0 D (Q50) 07/03/07 07/03/07 JDS 20.9 0.100 mg/L EPA 300.0 D (<250) 07/03/07 07/03/07 JDS 405 20.0 mg/L SM20 2540C E (<500) 0629/07 CLS 272 10.0 mg/L SM20 2320D E 07/03/07 CLS ND 10.0 mg/L SM20 232011 E 07/03/07 CLS ND 10.0 mg/L SM20 2320D E 07/03/07 CLS 700 1.00 umhos/cm SM20 2510D F. 0629/07 CLS 7.57 0.100 plI units SM20 4500-11 D E (6.5-8.5) 0629/07 CLS 272 10.0 mg/L SM20 23201) E 07103/07 CIS 0 coUl00mL SM20 9222B A (<I) 0629/07 DIX - PRELIMINARY - SGS Ref.N 1073087002 Client Name b1ike N. Anderson, P.B. Project NamdN Anderson Engineering Client Sample ID 19223 Old Glenn Ilwy Matrix Drinking Water PWSID 0 Sample Remarks: AO Dateslfimes arc Alaska Standard Time Printed Date/time 07/112007 10:24 Collected DattMme 06/292007 14:30 Received Dateffime 06/292007 15:25 Technical Director Stephen C. FAe Allowable Pmp Analysis P=miss Results POL Units Medwd Contains ID Limits Date Date [nit Microbiology Laboratory Total Coliform 0 col/IOOmL SM209222B -PRELIMINARY- A (<1) 0629/07 DLC 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 _�� 6 I. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) �.or 6 5e& .3 5XyW17 �/ G D _ sec Location (address or directions) //90/ (b) Applicant Name MIC -0162 2 f/r�F'���SU/✓ _Telephone: Home Z22Z Business Applicant Address /(90/ --/95-Is- (c) Applicant is (check one): Lending Institution Ste; Owner/builder ❑ ; Buyer ❑ ; Other ❑ (explain); —_ (d) Lending Institution — Telephone — Address _ (e) Real Estate Company and Agent — Address __— Telephone — (f) Mail the HAA to file following address: 2. TYPE OF RESIDENCE Single -Family 9 Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well g 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 OnsileA Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the Slate Department of Environmental Conservation attesting to the legality and status. 72-025 01,84) Page 1 of 2 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 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 ---Telephone Address /ZU'D (N, .33 AV/�51 .x//TEA/YL'fioeCACtE"t_A/< Date _ 5i col,loll-I&✓f(L s /"eOl-/ 51elgc, 1/AA /row YE /covoV,&O, 6. DHEP APPROV Approved for;4i_, rooms Approved Terms of Conditional Approval 11,419&-ZW 111vI) 1114y �s,�aame,elA gP`(�;•OF•'q U �.!,PN O /e :'• �:• a 9114 En a �gs Seal •. Y C. REID, JR. 7 19 ,r Cl: - 225! ..• .,(L, ,• : 0 Condi 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. l he DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and slate requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOAT HEALTH AUTHORITY APPROVAL (HAA) MUNICIPALITY OF ANCH010110;1KLIST - FEBRUARY 1984 DEPT. OF HEALTH & 264-4720 ENVIRONMENTAL PROTECTION Legal Description: 4.or6, 56K 3 SKYWAY sce Z4, r/Z/✓l iC4141 5, tir,, AK MAY 3 01986 A. WELL DATA RECEIVED Well Classification /NO111041,16 _ If A, B. C, D.E.C. Approved (Y/N) Well Log Present ®/N) — Date Completed —nj.1_L'z' —/� Yield _ Total Depth SS ` Cased to Ssr Depth of Grouting Static Water Level _ 3� 7` Pump Set At —C Y_k_A©w/'/ Casing Height Above Ground -- / Sanitary Seal on Casing&N) _ Electrical Wiring in Conduit ®N) Depression Around Wellhead (YQ@ Separation Distances from Well: To Septic/Holding Tank on Lot ; On Adjoining Lots /ZS ` > To Nearest Edge of Absorption Field on Lot 1301 -;On Adjoining Lots To Nearest Public Sewer Line N,/A To Nearest Public Sewer Cleanout/Manhole IVIA To Nearest Sewer Service Line on Lot N,/A Water Sample Collected by s1, KA/ ;Date Water Sample Test Results — �Ai/SFi�C%DAY Comments ?ZW Wt --Z!_ 77Z=5T B. SEPTIC/HOLDING TANK DATA Date Installed W–Al �size /Z�0L", No. of Compartments — Z — Standpipes (9N) — Air -tight Caps (9N) -- Foundation Cleanout (Y(9 -- Depression over Tank (9N) Date Last Pumped _ e3U�� Pumping/Maintenance Contract on File (Y/N) A(1A ; for AIIA Holding Tank High -Water Alarm (Y/N)- Temporary Holding Tank PermiC(Y/N) Separation Distances from Septic/Holding Tank: r r To Water -Supply Well To Building Foundation To Property Line 3S r f To Disposal Field =s- 7 To Water Main/Service Line NA To Stream, Pond, Lake, or Major Drainage Course >/OD r CommentsQQf1CrIA/FFG AS-Sell4r ellVAKAIZA06,G—Ok/45rr/—/_ 8Y P� LYCL l jS'l/P/�(G7 Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA 7 Soils Rating in Absorption Strata � < Type of System Design Date Installed /e3//f i Length of Field _ 0, :5 - Width Width of Field ?z, Z7 Depth of Field 4, 7' Gravel Bed Thickness 17-11 Square Feet of Absorption Area 9M Standpipes Present l' N) Depression over Field (Y© Date of Last Adequacy Test — Results of Last Adequacy Test SAR5/S /d CTD,eY 1 Oax ¢ B&PIC 0W Separation Distance from Absorption Field: To Water -Supply Well 130r'f To Property Line /0/ To Building Foundation S� / Lot To Water Main/Service Line N, To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments OC.4GCC/G,AT/oa oFA,P&--A /5 Y X /RO E&W r201/N-0, D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Ey To Existing or Abandoned System on On Adjoining Lots .5_0 To Cutbank (if present) 1VM Dimensions Manhole/Access "Pump 9.N'Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I h ve checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed + L I7 Date 5 30 86( Company S o1C. MOA No. Receipt No Date of Payment Amount: $ Page 2 of 2 72-026 (11/84) Engineer's Seal ALASKA uUIRMETAL COMROL SCI dUS, InC Engineerinq 6 enuironmenlal Studies 5/29/86 60247 HAROLD VERGASON SELLER—SAME HAROLD VERGASON 11901 JUNIPER 11901 JUNIPER ANCHORAGE ALASKA ANCHORAGE ALASKA 99515 99515 LEGAL:SKYWAY PARK BLOCK 3 LOT 6 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE -5/28/86 THE TYPE OF A13SORPTION SYSTEM IS A BED/CRIB WITH AN AREA OF 986 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 600 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 772 GALLONS. BASED UPON THE PEST DATA THE SYSTEM IS ACCEPTABLE FOR A 4 BEDROOM HOME. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC; TANK/PACKAGE PLANT WAS PUMPED ON 8/30/85 . THIS REPORT DOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR THE WATER SUPPLY OR WASTEWATER SYSTEM. FLOW 'PEST ON WELL WELL FLOW DATE --5/1/86 A FLOW 'PEST WAS PERFORMED ON THE WELL. '772 GALLONS OF WATER WAS PUMPED AT A RATE OF 4.9 GPM OVER A DURATION OF 3.5 HOURS. THE DRAWDOWN WAS 37.7 ' WITH A RECOVERY TIME OF 10 MINUTES AND THE STATIC WATER LEVEL WAS 31.7 FEET. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME. ADDITIONAI, COMMENTS :ra<,q SYSTEM WAS EVIDENTLY FR0ZEN FOR THE MAY 1 1986 TEST��G ��: Ja 4"I AND CAUSED FAILURE OF THAT TEST. +`Go„++++e +�{ cll i n i + � #91`1 JR. o !, Q��'li�llTJ�GSSiOt\�� v 1200 West 33rd Auenue. Suite B • Anchorage. Alaska 99503 0 901) 561-5040 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 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) LG 63 SK�wl-)v PIiRK sL� Location (address or directions) -L!__U1 ,J Q_N_I_PSL', R --- _�O(b) Applicant Name i�tQ—UU2WlTelephone: Home 3 qq2277 Applicant Address __JVI NFpF,f_Qp,,_14AICf Buqsiness Y 14 , (c) Applicant is (check one): Lending Institution ❑ Owner/builder X Buyer ❑ ; Other ❑ (explain); (d) Lending Institution _4/-11!/'-' / Telephone Address �" c , +..er ac�t;L�!-X (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single -Family % Multi -Family ❑ Other Number of Bedrooms _ q 3. WATER SUPPLY Individual Well �( 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)K' 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) 6 5 3 S A fli4144' ('FH'K 5. ENGINEERING FIRM PROVIDINu IN:)PECTIONS, 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 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 Slate codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm _(+ EC•5 /YC. Telephone _�S�% c�Q --- Addre Date cowl rloAIIAL _ 70 PU% Wll/ ,e iN CV1V,0(111_ (U)EL(_)) F/CL. OEPk65510NS OUCP 6F_ptIG 7'RNl 4- 6F�D. 6. DHEP APPROVAL A�r4)u11-c `k1 ze 544'7 f Engineer's SealAO r �®4,ram®qAQ °°•44 of cr-:�a art, °. 1 •0 • •• UY C, ROD, JR. q ' CE -2251i • 4 � o° tl�i °•• .�2r ......•'••�4o& 0 ®�%,Avom�a%4,a Approved for � bedrooms 1) Q C bate Approved Terms of Conditional Approval cwt L�CtiG�—� — IN c11iE� 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 Slate 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 DHEP do not conduct inspections or analyze data before a certificate is issued. The Mynicipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 I 72-025 n li84) -- -- - MUNICIPALITY. OF ANCHORAGE DEPT. OF HEALTH & ENVIRONMENTAL. PROTECTION MUNICIPALITY OF ANCHORAGE (MOA/ MAY O J 1986 HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARY 1984 264-4720 RECEIVED Legal Description: LG B3 -SKYW14VP691< A. WELL DATA Well Classification __I N A 01_001�If A, B,,, C,, D.E.C. Approved (Y/N) — It ' Well Log Present/N) Date Completed / IV aY Yield %.%iD Total Depth5 // — Cased to 6� / Depth of Grouting _ N/A Static Water Level A 31,' Pump Set At — ONKA109W Casing Height Above Ground — Electrical Wiring in Conduit (YA Sanitary Seal on Casing &N) Depression Around Wellhead (Ya Separation Distances from Well: To Septic/Holding Tank on Lot �© ; On Adjoining Lots Z To Nearest Edge of Absorption Field on Lot—J uU ; On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer Cleanout/Man hole_ 1a��� Al T✓o Nearest Sewer Service Line on Lot Water Sample Collected by �1i1711 �Je/1; Date — `ST�(, Water Sample "Test Results Comments ,S, B. SEPTIC/HOLDING TANK DATA 1-v 1 09'7 Date Installed _� A! Size — No. of Compartments Standpipes ON) Depression over Tank &N) Air -tight Caps &N) _- Foundation Cleanout (Ye Date Last Pumped _ O AU !2�5 Pumping/Maintenance Contract on File (Y/N) .(A ; for 1A(�Q Holding Tank High -Water Alarm (Y/N) ——_ Temporary Holding Tank Permit (Y/N) —— Separation Distances from Septic/Holding Tank: To Water -Supply Well V To Building Foundation R' /� / To Property Line 35 To Disposal Field — ,�i To Water Main/Service Lin/e� y'I`— --To Stream, Pond, Lake, or Major Drainage Course Comments � 04�� z431) L% UNAVAI.IRLF_ Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 10 Type of System Design V �� Date Installed 0 1 – g Length of Field q Width of Field Square Feet of Absorption Area Depression over Field ON) — Depth of Field `r / Gravel Bed Thickness �o y Standpipes Present 6N) Date of Last AdequacY Test Z�/�� Results of Last Adequacy Test !N/nJC�cpa/nc Separation Distance from Absorption Field: i To Water -Supply Well To Property Line To Building Foundation i / To Existing or Abandoned System on Lot L5 ; On Adjoining Lots �v V To Water Main/Service Line /,q To Cutbank (if present) Q(�� To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area z© /4- Comments /I/aN/7� '-' /0 KG00 /IDC4VU1rc7 /GS/ 1/77L'r DKat/."T vllcAl 74cn �R/L'3 GtP. �[-'Pk'G1f/a�✓ a✓�� �E� t/oG�/,✓�i Wl�'Ta� � 3y>`iLrf'AT�r/ly i�iTE/�'. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access ** Check Permitted Bedroom Rating Against HAA Request ** aff' Level at Vent(Y/N) Pumping Cycles during Adequacy Test. Meets MOA Icertify tha ha cke ,v rifie,orconformed to�all MOA and HAA guidelines ineffect on.thedate ofthis inspection. Signed Date / YrN / �G, / e®m����0 Company C MOA No.���zy ��®�°��`9, Receipt No. 7b . T I IUA°o �t 4*�,EROY Date of Payment 5`°°°°°Amount: $ �47 /a.,. C. REID, JR. ! PJEZC Fz ,J RaiAaGis 0CE - 2251 x, ,'41- W6et 67Page 2 of 2 �° 3 !J/1ley2 3/ifiiL�ttcT �O@ tCSSICt�,, -10' � 5' C'iiN�[LGG� cY/cc� ftK ?ivh'iIA4 &,4&17 72-026 (11/84) ALASKA 6JIROnUTAL COnTROL SCI)JC65, InC. Engineerinq & 3nuironmental Studies HAROLD VERGASON 11901 JUNIPER ANCHORAGE ALASKA 99515 SELLER—HAROLD VERGASON HAROLD VERGASON 11901 JUNIPER ANCHORAGE ALASKA 99515 LEGAL:SKYWAY PARK SUBDIVISION BLOCK 3 LOT 6 ADFsQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE -05/01/86 THE TYPE OF ABSORPTION SYSTEM IS A BED WITH AN AREA OF 984 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 150 GALLONS OF WATER PER DAY. THE SURGE CAPACITY OF THE SYSTEM IS 499 GALLONS. BASED UPON THE 'PEST DATA THE SYSTEM IS NOT ACCEPTABLE FOR A HOME OF 4 BEDROOMS. SEPTIC TANK ADEQUACY THE EXISTING SEPTIC TANK VOLUME OF 1250 IS ADEQUATE FOR THIS 4 BEDROOM HOUSE. THE SEPTIC TANK/PACKAGE PLANT WAS PUMPED ON 08/30/85 . FLOW TEST ON WELL WELL FLOW DATE -05/01/86 A FLOW TEST WAS PERFORMED ON THE WELL. 499 GALLONS OF WATER WAS PUMPED AT A RATE OF 4.9 GPM OVER A DURATION OF 3..5 HOURS. THE DRAWDOWN WAS 37.7 ' WITH A RECOVERY TIME OF 10 MINUTES AND THE STATIC WATER LEVEL WAS 31.7 FEET. THE WELL IS ADEQUATE FOR THIS 4 BEDROOM HOME. .. :............a UR C. RCIU, JR. C[ - 2251 1200 West 33rd Auenue. Suite 5 9 Anchorage, Alaska 99503 9 907) 561-5040 05/09/86 ALASKA ENVIRONMENTAL dDD L6 8 SKY WAY -jMRK S 0 CONTROL SERVICE INC. SHEET NO. - OF 1200West 33rd Avenuo, Suite B ANCHORAGE, ALASKA 99503 CALCULATED BY �rK DATE s5 2?L _ (907) 561.5040 CHECKED BV DATE -- 2 0 ATEZ0 ALASKA ENVIRONMENTAL CONTROL SERVIC( INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 561.5040 SHEET NO CALCULATED DY CHECKED BY- OF DATE_ �-A/�&6-- - DATE __ Ir/1 I C?s— wELL i i I I \ TAN, K NOUSE / c vl 5UITA'6LE /tREA' GIIRR6E I I I SVITAUC UP6RA0F ARl-A � I NOTE; NO U/6L1.5 w171+itU too' OF PAOPOsEA UPGRADE 6RCA.5