HomeMy WebLinkAboutSUN VALLEY BLK 3 LT 8un Valley
lock
Lot 8
078-111
-03
Municipality of Anchorage
Development Services Department
Building Safety Division -
On-Site Water and Wastewater Program, 4700 Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 4
www.ci.anchorage.ak, us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: OSPl11094 PID Number: 078-111-03
Name:
Clifton & Linda Ricketts Wastewater System: [] New [] Upgrade
Address:
2900 Sun Valley Drive ABSORPTION FIELD
Phone: Number of Bedrooms:
[] DeepTrench [] Shallow Trench [] Bed [] Mound [] Other:
LEGAL DESCRIPTION Sol, Rating: Total Depth from originalgrade:
GPD/Ft2 Ft.
Block: Lot: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pipe:
3 8 Sun Valley Ft. Ft.
Township: Range: Section: Fill added above original grade: Gravel Length:
Ft. Ft.
Well: [] New [] Upgrade Gravel width: Number of lines: I Distance between lines:
Ft.I Ft.
Classification (Private, A, B, C): Total Depth: Cased to: Total absorption area: Pipe Material:
Existing Private Ft. Ft. Ft2 3034 PVC
Driller: Date Drilled: Static Water Level: Instafler: Date Installed:
Ft. SOUTHFORK CONST. 7/2/2011
Yield: I Pump Set at: Casing Height Above Ground:
GPMI Ft. Et. TANK
SEPARATION DISTANCES [] Septic [] Holding [] S.T.E.P. [] Other:
T~_To Septic Absorption Lift Holding ~ublic/Private Manufacturer: Capacity:
From~
Tank Field Station Tank Sewer Line Anchorage Tank 1000 Gal.
Material: Number of Compartments:
We, 106.7 101.2 Steel 2
Su,aceWater 100+ ~ / LIFT STATION
Lot Line 83,8~ Size: Manufacturer:
Gal.
Foundation 5.3 "Pump on" lever at: "Pump off' level at: I High water alarm at:
in in.I in.
Curtain Drain N/A Pump Make & Model Electrical Inspections performed by:
Remarks:
Septic tank replacement only, Rocks and planter placed to BENCH MARK
Location and Description:
prevent driving over tank. Existing tank abandoned per code. GARAGE FF
Assumed Elevation:
100,0 Ft.
Engineer's Stamp
Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1st 7/2/2011
2nd
Development Services Department Approval
Conditional Approval Date:
// ·
' ~ Date: 7-/,).--//
Reviewed and approved by: f~L~l .,/' C/~/./, /i
* VERIFY GRADES BEFORE CONSTRUCTION ' ~ A B
· ' ' ~. FC 4.0 30.0
LOT UND~ELOPED ¢/ / / % ~
NO WELLS OR SEPTICS
'.. p . '~
'
.. ~ I ....... , :, , ~ . _%
~ .99.5
W~ 4.0
~ WELL (E) __ ~ ~ , 95.5
% 1NEW 1000 g - ,
SEPTIC
/
TANK
~ PROFILE
RECORD DRAWING P.0, BOX 100217 ANCHORAGE, AK 99510 ~" ~z~ll~ 7/5/11
PHONE (907) 272-8218 FAX (907) 272-8211 ~... ~-.~ ~ Scene
SUN VALLEY, BLK 3, LOT 8 ~ ..... ~ ...... ~ P.LD. NO
~ ~ 078-111-03
CLIFTON & LINDA RICKETTS PERMIT NO.
2900 SUN VALLEY DRIVE ~ ~. 0SPl11094
PLAN EAGLE RIVER, AK 99577 ~ " " Sheet
Permit Number: OSP111094
Tax Code Number: 07811103000
Work Type: Septic
Permit Effective Dates: June 10, 2011
On-Site Wastewater Disposal System Permit
MUNICIPALITY OF ANCHORAGE
Development Services Department
On-Site Water & Wastewater Program
4700 Elmore Road, PO Box 196650
Anchorage, AK 99519-6650
Telephone: (907) 343-7904
Upgrade
to June 09, 2012
Design Engineer: PANNONE ENGINEERING SERVICE
Subdivision: SUN VALLEY
Site LegalAddress: SUN VALLEY BLK 3 LT 8 G:0859
Owner/Address: PANNONE ENGINEERING SERVICE
PO BOX 100217 ANCHORAGE AK 99510
Site Mailing Address: 2900 SUN VALLEY DR, Eagle River
Lot Size in Sq Ft: 79384
Total Bedrooms: 3
This permit is for the construction of:
N Disposal Field Y SepticTank N Holding Tank N Privy N Private Well N Water Storage
All construction must be in accordance with: 1. The attached approved design.
2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater
Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80).
3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services
Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either:
A. Open and Close on the same day.
B. Covered, sealed, and heated to prevent freezing.
Special Provisions: The vehicle barrier constructed around the septic tank shall be permanently
installed.
MUNICIPALITY OF
ANCHORAGE
Community Development Department
Development Services Division
On-Site Water & Wastewater Program
Mayor Dan Sullivan
Phone: 907-343-7904
Fax: 907-343-7997
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D.
Property owner(s)
Site address Z_~¢o
Legal description (Sub'd., Block & Lot)
Legal description (Township, Range & Section)
Lot Size ~¢ 5 $~ Sq. Ft. Number of Bedrooms
Day phone
P-i u,C& :,,/¢
THIS APPLICATION IS FOR: THIS APPLICATION IS AN:
([~ all that apply)
Absorption Field [] Initial []
Septic Tank [~ Upgrade [~
Holding Tank [] Renewal []
Privy []
Private Well []
Water Storage []
THIS APPLICATION INC, L_UD Srr.~_A~VARIANCE / WAIVER REQUEST FOR:
I certify that the above information is correct. I further certify that this application is being made
for a Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signa~re of-prop~r'[~; (~ f~er or authorized agent)
RushFees: C~OO" ~'~%
Waiver Fees:
Date of Payment: (,o - ~''-'\'~ Date of Payment:
Receipt Number: O ~'O ~ ~ O Receipt Number:
Permit No. C3 5 P I[! IDC~ f~ Waiver No.
G:\Building\On Site\Forms\Client Forms\Permit App_010411 .doc (Rev. 1/11 )
Pannone En§ineerin§ Services LLC
Steven R. Pannone, Principal
Registered Professional En§ineer
E-mail: steve@l~anengak.com
June 6, 2011
Municipality of Anchorage
Development Services Department
On-Site Water & Wastewater Program
4700 S. Bragaw Street
Anchorage, Alaska 99519
Subject:
Sun Valley, Block 3, Lot 8
Emergency Septic Tank Replacement Permit Request
Ladies and Gentlemen:
I am writing to request that a permit to install a new 1000 gallon Septic tank be issued for this
lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is
developed. The existing septic system was designed and installed for a three-bedroom house and
is operating adequately for three bedrooms. The existing steel 1000 gallon tank is located
directly in front of the garage door where it is driven over and parked on. The existing tank will
be filled with clean gravel or concrete and abandoned per code. The surrounding lots are served
by private wells and there are no wells within 100 feet of the proposed septic tank. This lot is
served by a private well that is 101' from the proposed septic tank. PES will verify all required
separation distances at time of installation.
Upgrade Tank Design.
a. See Sheet 1 of 1 of the plan set
2. Surface Water: There is no surface water within 100 feet of the proposed system. The
proposed systems will maintain at least 100 feet from all surface water and drainage ditches.
3. Topography: The portion of lot 8 around the tank slopes from east to west at
approximately 2%. The proposed installation will be located in the central portion of the lot next
to the existing septic tank and the garage.
Maiiin{¥ P.O. Box 2.0023.7~ Anchorage, AK 995::I. 0-027
¢t":ysicat: 6:!5 ~.ast 82~ Ave, Cuite B6~ Anchorage, AK 99505
'T'elephone: (907) 272-~82,~8 FAX: (907) 272,-.8225
Page 2 of 2
The proposed installation will not affect the future development of the surrounding or existing
lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you
have any questions or concerns, please contact me at 272-8218.
Sincerely,
Steven R. Pannone, P.E.
Owner/Civil Engineer
Attachments:
~, m sx Box 1.00217~ Anchoraa% AK
Physi(:af~ 6~.~ ~"~, ~"~' .... ~ ....
.... ::.~s. ~sz" Ave, Cu~.e B6, And'~orage, At< 9950...~
Telephone'. (90';0 272~82ZS FAX: (907} 272,~S2~
* VERIFY GRADES BEFORE CONSTRUCTION '
~ ' 9
~ WELL (E) ~
k /
No~: P~O~
PHONE (907) 272-8218 FAX (907) 272-8211 · Scale
~..'da ~ ~ '.~.'¢j ~"=5o'
P.LD.
NO
CLIFTON
~¢i ~'. CE 8149 .';%~ PERMIT NO.
2900 SUN VALLEY DRIVE f~i~.. ..;~ xxxxxxxxx
PLAN EAGLE RIVER, AK 99577 ,'~ ....... ~'~
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
ENVIRONMENTAL ENGINEERING DIVISION
825 L Street- Anchora§e, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAl_ SYSTEM AND/OR WELL INSPE;CTION REPORT
PHO~
UPGRADE
NAME
MAILING ADDRESS
LEGAL DESCRIPTION
____ Lo_~8
LOCATION
DISTANCE TO: /tJC~-~-- ~ ~
JAbsorption area
8f
Manufacturer ~--~.~ I~' ~' ~
Liq. capacity in gallons
DISTANCE TO:
IF HOMEMADE:
Well
Manufacturer
llnside length
Dwelling
DISTANCE TO:
Length of each llne
No. of ,i,,~ J -~ (
Top of tile to finish grade
Length
Width
Foundation
'Total length of lines
Material beneath tile
Depth
Dwelling
Material
Material~ [O ·
Nearest lot line
ITrench width
,~0 inches
inches
NO. OF BEDROOMS
PERMIT NO.
No. of compartments
Liquid depth
PERMIT NO.
~,id capacity ir~ gallons
PERMIT BO.
PERMIT NO.
Type of crib Crib diameter Crib depth Total effective absorption area
Well Building foundetion Nearest lot line
DISTANCE TO:
CJass/~¢~___ -'[2.~ Depth )riller Distance to lot llne
Building foundation Sewer line Septic tank
DISTANCE TO:
OTHER
PIPE MATERIALS
SOIL TEST RATING
INSTALLER
REMARKS
APPROVED DATE
72-01~3 (Rev. 3278) (~
LEGAL
Department f Health and Environments Protection
825 ~ Street, Anchorage, AK. 39501
~ P * * ~' HANDWRITTEN PERMIT * * *
Permit ~~~ WELL AND/~ ON-SITE SEWER PERMIT
Applicant: . ~ ~. Mailing Address: 5~ ~ff ~ ~ ~'~
Location: Phone Number:
Legal Description: Z~'~' 8 C{/~ % .~'~V~¥__~/~ot S±ze:
Type of Soil Absorption System Is:
Trench: ~ Drainfield: Seepage Bed: __. Holding Tank:
Maximum Number of Bedrooms: _ ~_ Soil Rating(sq.ft/br) !~-
DEPTH
The Required Size of the Soil Absorption System TS:
LENGTH ~,~' ' J
· GRAVEL DEPTH _~ WIDTH
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). 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(~G) TANK SIZE = ~D GALLONS * *
Permit applicant has the responsibility to inform this department during the
installation inspections of any wel~.s adjacent to this property and the number
of residences that the well will serve.
* * * TWO(2) INSPECTIONS ARE REQUIRED * * *
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 fee~
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 1 9 ] * * *
I certify that:
(1) I am familiar with the requirements for on-site sewers and wells
set forth by the Municipality of Anchorage.
(2) I will install the system in accordance with codes.
(3) I understand that the on-site
the residence is remodeled to
S igne'~: .~~~-~-.~-..~_~ ,
as
SOILS LOG
PERFORMED FOR:
LEGAL DESCRIPTION:
1
2
4
8
9
12-
13-
14-
15-
16-
17-
18-
19-
20-
MUNICIPALITY OF ANCHORAGE
[] PERCOLATION
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
TEST
825 L. Street, Anchorage, Alaska 99501 264-4720
SOILS LOG - PERCOLATION TEST
IF YES, AT WHAT
DEPTH?
Gross Net Depth to Net
Reading Date Time Time Water Drop
PERCOLATION RATE (minutes/inch)
CERTIFIED BY:
.WATER WELL
3TATE OF
LOCATION OF WE. LL (Please complele either ~a, lb er lc.)
' '(~ 6. r~ Cobl~ [ool [~ ~'ory ~ Driven C3Dug
; '' ~] Irrigotlon ~ Roci,arg. ~ Commericel
........... Long/h of Drop Pipe fl. capuciJy
.... gp.m
STATE OF ALASKA
DEPARTMENT OF NATURAL
Division of {3eologicol e~ Geophysicc!
LOCATION OF WELL (Please complete either la,.Ib or lc.)
I~. Borough Subdivi,ion Lot Block ~l '/4qtr,:
, ;
I~. DISTANCE AND DIRECTION FROM ROAD INTERSECTIONS =
Street Address and .Area of Well Location
2. WELL LOG
Material Type
C ..... ;-~vc~ ~::]',.d
~..'.i" :>. 'f ,:') .....~ ~ <; .i.;'L :(
Drilling Permit No,
A,D.L, No,
Section No. Township NE] Range EEl Meridian
sUl wU]
$, OWNER OF WELL:
,, I'.;:c , Ce.r]..b'J. sotel3.
Feet Below
Surface
Top Bottom
o 16
/
99~77
4. WELL DEPTH: (final) 5. DATE OF COMPLETION
q c~r~ ft. o - q R - .c -~:
~..- . ,,- , ,,...~
6.
[-'] Cable tool [~..R..o. tary r-'] Driven ~ Dug
r"] Auger [~ Jetted [[[[[] Bored [~ Other:
7. USE:~J~ Domestic
Public Supply J~J Industry
E] Irrigation E] Recharge E] Co~nmericat
[~ le~t Well J-"J Other:
8, CASING: E] Threaded j~ Welded
..
diam. in to ;~'
...... 'fl. Depth Weight
diam. in. to ft. Deplh Stickup_
lbs./ft.
ft.
9. FINISH OF WELL: ,
Type' Diameter:
Slot/Mesh Size: Length:
Set between ft. and
Backfilling Gravel pack
ft.
I0. STATIC WATER LEVEL: ft.
r-J Above or J-"J Below land surface
Equipment used'
/ /
Date
II. PUMPING LEVEL below land surface and YIELD
ft. after hrs. pumping
ft. after
_
I ?.,GROUTING Well Grouted:
Material' E] Neat Cement
PUMP: (if available) HP
Length of Drop Pipe
E] Subm, E] Jet
hrs. pumping
j-]Yes
~ Other'
ft. capocily
Centrifical
Other
g,p,m,
g.p.m.
g .p,m.
16. WATER WELL CONTRACTOR'S CERTIFICATION:
14. REMARKS:
15. Water Temperature o
OF
r-']c
This well was drilled under my jurisdiction and this report is true lo the best of my knowledge and belief;
~,"'- ~ :'.:';' '" ,t,n '}.;~' j.]. 'i_. :i ~i "' [,?', .,,~'~: "...' ....":',
Registered Business Name ! Contract License Number
...... ~" ~'~ ~.'~:5 '2
...... (l ('~h. E,':::.. F'~ (: .[,:i_v (:,' :;': ....
Address ',. ('), i:;'[;): ,~ ,' ..... ' ....
..,"' .C:: : ,
,,, l..,i ,,:: ,.,,. /"! ,./(: ;:;' ,~,,, Date
· , .-
I ' Authorized Rel~resenlolive /
Form O2-WWR (11/81)
Copy Distribution' WHITE-State DGGS, PINK-Driiler~ CANARY-Customer
Municipality of Anchorage
l:)evelopmenl Services Departrn~nt
Building Safety Division
On-Site Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519~6650
www. muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING
05 ? ~'~
Parcel I.D. o78-~z-o-~
GENERAL INFORMATION
Complete legal description Sun~8
Location (site address) 2 oo SunValle Drive Eale River AK
Current Property owner(s) Cliff& Linda Ricketts Day phone, 748-934~
Mailing address
Lending agency
Mailing address
COSA #
Expiration Date:
2 ooSunValle Drive Ea le River AK
Day phone
Real Estate Agent Eva Loken/Prud. Jack Whit Vista Day phone. 689-6476
Mailing Address z66 Centerfield Dr. Ea le River AK
Unless otherwise requested, COSA will be held by DSD for pickup.
B'ED.OO.S-
,Typ E ;'OF,,WATER,iS U pp Ly:
ii~di~i~.uai ~,ell
Ir~idMdual Wate? Storage
Community ClaSs
Public 'Water 'System
Well
TYPE OF WASTEWATER DISPOSAL:
[] Individual On-site [~
[] Individual Holding Tank [--]
[] Community On-site [~]
[] Public Sewer ~
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On-Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of On-Site Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of 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, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage flies 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 Pannone Engineering Services, LLC Phone. 272-82:1.8
Address P.O. Box ~oo2z7, Anchorage, AK qgr;~.o
Engineer's Printed Name. Steven R. Pannone, P.E. Date
Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in
accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions
encountered at the time of the test, and separation distances measured to readily identifiable features.
The operational life of all wells and septic systems depend on the local soil condition, ground water
levels that may fluctuate during the year, and the water usage of the family being served by the system.
These conditions are outside the control of the evaluator of this system. All systems eventually fail and
satisfactory test results do not guarantee future performance of the system, nor do they guarantee that
there are no hidden defects or encroachments. PES can therefore not provide any warranty for future
performance nor give any estimate of how long the system will continue to meet the operational
requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed
above. Any reliance upon or use of this report by any other person or party is not authorized nor will it
confer any legal right whatsoever.
5. DSD SIGNATURE
L'//Approved for ~ bedrooms.
Disapproved.
Conditional approval for
bedrooms, with the following stipulations:
Attachments: COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
By: ~/'
(Rev. 11/05)
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
'P'~G~Original Certificate Date:
Municipality of Anchorage
Development Services Department
Building Safety Division
On-Site Water &.Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description:. Sun Valley, Block =1 Lot 8
A. WELL DATA
Well type _P
Date completed ~1~81=.q8~
Total depth =.oo ft.
Date of test
Static water level
Parcel ID:. o78,~z=-o=l
Well production 5
WATER SAMPLE RESULTS:
Coliform Ne_~ colonies/100 mL
Arsenic: ND ug/I
SEPTIC/HOLDING TANK DATA
If A, B,' or C provide PWSID #.
Sanitary seal (Y/N) Y
Cased to ~6 ft.
FROM WELL LOG
qla81aq8:l
g.p.m.
Well Log (Y~N) .Y
Wires properly protected (Y/N) Y
Nitrate ND mg/L
Date of sample:
Casing height (abo~
AT INSPECTION
24.
....'~
Tank Type/Material Anchorage Tank Steel
Tank size :~ooo gal.
Foundation cleanout (Y/N) Y
Date of pumping
C. ABSORPTION FIELD DATA
Date installed
Length 68
Total depth _6 ft.
Collected by: .L.a~
Date installed
NUmber of Compartments _2
Depression over tank (Y/N) N
Pumper
e ground) 2~+ in.
fto
g.p.m.
~rapannone
Gravel belov pipe =l.o ft.
Depression over field N
For 3 bedroo ms
Water added4.7o gal. ~ New depth_6 in.
Absorption rate >= 4.50+
g.p.d.
If yes, give .date .....
Soil rating
ft. Width 2.5
Eft. absorption area 4..08 ft2
Date of adequacy test .. Sl212o~= Results (Pass/Fail) .......
Fluid depth in absorption field before test _o in.
Elapsed Time: ~_5 min. Final flUid depth _.o in.
Any rejuvenation treatment (past 12 mo.) (Y/N & type)...N
System typei Trench
(g.p.d./~ or ff2/bdrm) ~-~5
ff.
Monitoring tube _Y
Pass
Cleanouts (Y/N) ~
High .water alarm l(Y/N) NIA
LIFT STATION
Date installed
"Pump on" level at
Datum
· in.
E. SEPARATION DISTANCES
Size in gall _o~.~.
"Pump off" lev~a~f
Cycles test~ ~,
Manhole/Access (Y/N)
High water alarm level at
Meets alarm & circuit requirements?
in.
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift s{ation on lot ~.oo+
Absorption field on lot ~eo+
Public sewer main ... NIA
Sewer/septic service line 2;+
Animal containment areas ~oo+
On adjacent lots ~.oo+
On adjacent lots ~.oo+
Public sewer manhole/cleanout N/A
Holding tank ~oo+
Manure/animal excrete storage areas
loo+
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation ~+
Water main N/A
Wells on adjacent lots
Property line. =.o+
Water service line :~+
Absoq~tion field ~.o+
Surface water ~.oo+
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line .?a ' Building foundation ~o+ Water main NIA
Water Service line ~+ Surface water ~o~ Driveway, parking/vehicle storage ~o+
Curtain drain None KnoWn Wells on adjacent lots
F.
COMMENTS
I ce~ t~t I have ~ined through field inspe~ions and
review of Municipal m~s ~ the ~ove systems are in
con~orm~ w~ MOA COSA g~elines in effo,t on t~,
Engineer's Print~ Na~ ~ev~ R Pan~ P E
COSA Fee $
Date of Payment
Receipt Number
(Rev. 11/05)
Waiver Fee $ ,,
Date of Payment
Receipt Number
SGS ReL# 1112225001
Client Name Pam~one Eng. Srv. Printed Date/Time 06/09/2011 8:37
Project Name/# Sun Valley BK3 LT8 Collected Date/Time 06/02/2011 11:45
Client Sample ID Sun Valley BK3 LT8 Received Date/Time 06/02/2011 15:30
Matrix Drinking Water Technical Director Stephen C. Ede
PWSID 0
Sample Remarks:
4500NO3-F - Total Nitrate/Nitrite - MS recovery is outside of QC criteria. Refer to LCS for accuracy requirements.
Allowable Prep Analysis
Parameter Results LOQ Units Method Container ID Limits Date Date Init
Metals b~ ICP/MS
Arsenic
ND 5.00 ug/L EP200.8 C (<10) 06/03/11 06/06/11 NRB
Waters Department
TotalNitrate/Nitrite-N ND 0.100 mg/L SM204500NO3-F B (<10) 06/07/11 AYC
Microbiolog~ Laboratory
E. Coli
Total Colifom~
Negative 1 100mL SM20 9223B A 06/02/11 DLC
Negative 1 100mL SM20 9223B A 06/02/11 DLC
"~ ~ '"'~ LOT 7 \
~'.~ c.o. /,¢~/ ' \ x \
; ,
888* 54' 3~"W 405.87'
UNDER NO ClRCUMST~CES ~LD ~ AS-BUILT BE U~D FOR C~S~UC~ON OR F~ ESTABU~ING B~ND~Y ~ ~NCE UNES.
~E SUR~Y~ TAKES RESP~BILI~ FOR ~E INI~AL mANSAC~ON ONLY AND ASSUMES FINANOAL UABIU~ ONLY F~ ~E COST ~ ~E SURLY.
USeD DISTANCES PREVAIL O~R SCAENG. REPR~UC~ON MAY CAUSE ERR~S IN SCA~.
~ co, m~ SUEVEY TYPE S~BOLS
~ ~ ~ S~C~E AS-~LT ' ET REB~ ~ ~ DRAINAGE~ ~ ASPHALT
~ ~0T ~ . . . ~LT... LOT~... T~HY~O FOUND REBAR ~ ~ ~ ~D ~NCE [~m"'~v"'7'l C~CRE~
~ ~-~ILT . . . NO ~S ~T ~ ~~ ~-BUILT... NO ~ ~T ~ AS~MED ~V. ~ ~ X MET~ FENCE ~ ~D DECK
PLOT PLANS & LOT SUR~YS NO~:
IT IS mE RESPONSIBILI~ OF mE BUlmER OR O~ER, PRIOR TO ONLY mOSE IMPRO~MENTS ABO~ GROUND AND ~$1BLE ~LL BE
CONS~UCTION, TO ~RIFY PROPOSED BUI~ING GRADE RELATIVE SHO~. FENCES, ~LLS, SEP~C CLEANOUTS, SIDEWALKS, DRI~WAYS,
TO FINISHED GRADE AND U~U~ CONNEC~ONS AND TO DE~RMINE ETC., ARE SHO~ IN ~EIR APPROXlMA~ LOCA~ON, ONLY. SNOW
~E EXIS~NCE OF ANY EASEMENt, CO~NAN~ OR RES~IC~ONS MAY PRE~NT SOME IMPRO~MEN~ FROM BEING SEEN AND LOCA~D.
~ICH DO NOT APPEAR ON THE RECORDED SUBDI~SION PLAT. ALL DISTAN~E~ ARE RECORD UNLESS OTHER~SE NOTED.
SURLY CER~FICA~0N _~~ ~repored by
~,~ ............. ~ ~ Robert E. dohns, dr. & Assoc.
~~'~~ ~i ......... ~ Professionol kond Surveyors
--"-""-' l?
~AGE, A~SKA 99504
~ ~ ~ ~ ~' ~ ~; ~ Scale: Rec. Lot S.F. Rec. Plot Rle No.
r,.~ s~c~ .s-~,~ ,.~-~
~J c ~ ~.. ~y ~ ~t ~ · ,. Legal De~iption:
~-,-,-~-~ ~ ~o ~ ~* SUN VALLEY SUBDIVISION
--~ '~,[~[~ LOT 8 BLOCK 3
Municipality of Anchorage
P.O. Box 196650 · 4700 Elmore Road
Anchorage, Alaska 99519-6650 · (907) 343-7904 · Fax (907) 343-7997
http://www.muni.orq/Onsite
Development Services Department
On-Site Water and Wastewater Pro,qram
partment
**** VARIANCE/WAIVER REVIEW ****
WR#: 111151 HA#: 111237 Permit#: 111094
PID#: 078-111-03
Legal Description: Sun Valley B-3 L-8
Engineer: PES
Applicant: Cliff & Linda Ricketts
Your request for a waiver of the required 10 feet horizontal separation from the absorption field
to the property line has been approved. The approved separation distance is 3.0 feet.
This 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.
Waiver is Granted: X Waiver is not Granted:
Rec#: 095547 Amount: $200.00 Date Paid: 717/11
**** VARIANCE/WAIVER REVIEW ****
MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONMENTAL HEALTH
CERTIFICATE! OF INSP[:CTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
264-4720
Application Date _.. Augu. et 22,~/__9~6_.____
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
~Lot 8; Block 3; Sun Valley
Location (address or directions)
,* Sun V~16¢ Road - (cedar sided with 9re&n ~[im)
(b) Applicant Name M~r~ Lynch Telephone: Home
(c)
Business
Applicant Address 10900 NE 4th S.fJ~eet¢ C-9100, B~..levue, Washington 98004
Applicant is (check one): Lending Institution I-I; Owner/builder ~(; Buyer []; Other [] (explain);
Bu_~:
(d)
(e)
Telephone __
(f) ~ta~the HAA tO the
Lending Institution No/~th~n Mort,~a.qe Telephone
Address _ Eac]le Riv~_L, Alaska
Real Estate Company and Agent H¢.J'/.,O0zg& HomeS/Sazanne ~ool
Address SR Box 126 Eagle ~v~ Road, E~e RZv~ Alaska 99577
694-4994
following address:
S & S E~gineerin~
E~ Riv~ A~k~ 99577
ord~[ed by Suzanne Cool
TYPE OF RESIDENCE
Single-Family E~, Multi-Family []
Number of Bedrooms ~_
Other
WATER SUPPLY
Individual Well,[~ Community E] Public []
Note: If corn munity well system, must have written confirmation frora the State Department of Environmental Conservation
attesting to the legality and status.
SEWAGE DISPOSAL
Onsite..~[ 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 I of 2 ~2 025 (1
ENGINEERING FIRM PROVI[)ING ..~SPECTIONS, TESTS, FILE SEARCIt, DA'f, .4ND INFORMA'rlON
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 S & S ENGINEERING
SRB l~SX
Address
EAGLE RIVER, AK t~9577
Date
Telephone
DNEP APPROVAL
Approved for ~.~bedrooms by
Approved %~ Disapproved
Terms of Conditional Approval
Conditional
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 Stete 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 not responsible for errors or omissions in the
professional engineer's work.
Page 2 of 2
72-1)25 (11/84)
WELL DATA
"o ~.,~.~;'. MUNICIPALITY OF ANCHORAGE (MOA)
'~..,,':"'( ~?~ ,HEALTH AUTHORITY APPROVAL (HAA)
~'~, '~ ~( ~' ' Legal Description: ~
Well Classification
Well Log Presentl~JJ
Total Depth _ \~'
Static Water Level
If A, B, C, D.E.C. Approved (Y/N)
Date Con- pleted _ ~/~:~'~ Yield
Cased ~o ¢'~fu~' Depth of Grouting '~"~
'Z.,.~,~- ~m," Pump Set Al
Casing Height Above Ground
Electrical Wiring in Conduitd~N)
Separation Distances from Well:
To Septic/Hcld~'~J Tank on Lot
Sanitary Seal on Casing ~[~N)
Depression Around Wellheac [Y/(~
.; On Adjoining Lots
To Nearest Edge of Absorption Field on Lqt _ ~ ~'[::;'~ ~'_; On Adjoining Lots
To Nearest Public Sewer Line "'% ]b, To Nearest Public Sewer
Cleanout/Manhole
Water Sen- pie Collected by
Water Sam pie Test Results
Comments '~' ",v~ ~,-~
¢ I ~ To Nearest Sewer Service Line on Lot ~)--'~'~ ~"~
B SEPTIC/F~L-£IING TANK DATA
Date nstalled '~1~'~1 -~:'?'~ . Size
Standpipes~N) Air-tight Caps
DePression over Tank (Y/I~D
Pummng, Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N)
Separation Distances from Septic/,N~ldlng-Tank:
No. of Compartments
Foundation Cleanout
Date Last Pumeea
"~ J ,~ . fo-
Temporary Holding Tank Permit (Y/N) ~,..~/~,/
To Water-Supply Well
To Property Line I, jc~ t.~r
To Water Main/Service Line
Course ~ C:'c~ ~
To Building Foundation
__ To Disposal Field
't ~ I ~ To Stream, Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(lt/84)
ABSORPTION FIELD DATA
Soils Rating in Absorption Strata t ~"'~'~ 1'~'~4~,.~ Type of System Design '""~
Date Installed ~ ~C~ ~ ~;>'~ Length of Field (.¢2~> ~'/
Width of Field "~c~'~ Depth of Field
Square Feet of Absorption Area
Depression over Field (Y/~
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well ~ ~c=, ~ ,..tO
To Building Foundation ¢.~
Lot
To Water Main/Service Line
Gravel Bed Thickness
'''4= ~"/ Standpipes Present
Date of Last Adequacy Test
To Property Line \ C> I..~.
; On Adjoining Lots
To Cutbank (if present)
To Existing or Abandoned System on
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
Comments
D. LIFT STATION
Date Installed
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Dimensions
Manhole/Access (Y/N)
/"Pump Off" Level at
Vent (Y/N)
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, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
S & S ENGINEERING ¢~"~/,¢' 6'
Signed Date
SR B 196X ....
c°mpan~6,GiE RIVER, Al( 995~ MOA No.
Receipt No. ~ % - ~
Date of Payment ~ ~/ ~ %
Amount:
Page 2 of 2
72-o26 (11/84}
,'~IUNICIPALITY OF ANCHORAGE,
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
DIVISION OF ENVIRONIVIENTAL HEALTH
CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL
OF ON-SITE SEWER AND WATER FACILITY
2§4-4720
Application Date ~-~-/~ ~ 6r'~'"'
GENERAL INFORMATION
(a) Legal Description (include lot, block, subdivision, section, township, range)
Location laddress or directions)
(b) Applicant Name ~~~ Telephone: Home Business
Applicant Address _~~_ ~~ "~N~,~
(c) Applicant is (check one): Lending Institulion []; Owner/builder D; Buyer E]; Other ~ (explain);
(d) Leading Institution ~L%~_. ~.~,~ _ Telephone
Address ~Z,~ ~/~-~t.-'
(e) Real Estate Company and Agent _. ~,-¢~
Address
Telephone
(f) -Mail-the HAA to the following address:
TYPE OF RESIDENCE
Single-FamilytL~ Multi-Family [] Other
Number of Bedrooms .....
WATER SUPPLY
Individual Welll~L Community [] Public []
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
SEWAGE DISPOSAL
Onsite[~L' Public E] 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.
5, ENGINEERING FII'IM PItOVII)ING ~,~$PECTIONS, TESTS, FILE SEARCH, DA'I'>~ .~ND INFORMATION ~- "
A~ certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health
Au[horit~ Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate
for (he number of bedrooms and type of structure indicated herein. I furtl)er 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
y/~lev/ater disposg~l system is in compliance wi~h a~l Municipal and State codes, ordinances, and regulations in effect on
the date of this inspection.
~me el Firm ~ ....... , ..... ~ ~ Telephone
Address '~. , ,~ ;~ ':: .'
Approved for ~ _~.~..~.~. bedrooms
Terms of Conditional Approval
CAUTION
The Muncipai~ty 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 DHIEP does this as a courtesy to purchasers of homes and their lending
institutions m order to satisfy certain federal and state 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
WELL DATA
Well Classification
Well Log Present ~N) _
MUNICiPALiTY OF ANCHORAGE
MUNICIPALITY OF ANCHORAGE (MOAl DEPT. OF HEALTH &
HEALTH AUTHORITY APPROVAL (HAA) I~NVIRONMENTAL PROTECTION
CHECKUST- PE.RUAR¥ 49.4
264-4720 k, tJO
Legal Descri~..tion:
Total Depth
Static Water Level
Casing Height Above Ground
Electrical Wiring in Conduit ~/N)
Separation Distances from Well:
To Septic/H~o!dk~g Tank on Lo1
To Nearest Edge of Absorption Field
To Nearest Public Sewer Line
Cleanout/Manhole
Cased to
If A. B. C, D.E.C/Approvea (Y/N)
Date Comoleted ~/~-~"~ _ Yield
Depth of Grouting
Pump Set Al ~...~f~l~,
Sanitary Seal on Casing ~N)
Depression Around Wellhead (Y~(~
: On Adjoining LOtS
_; On Adjoining Lots
To Nearest Public Sewer
Water Sample Collected ey
Water Sample -I-est Results
Comments
To Nearest Sewer Service Line on Lot
~,.~ ~ ~,-,-~ ~_..~ t/~ ~1,, 1 n.J ~--, Date
B. SEPTIC/Id4~Ct~N4il 'rANK DATA
Date Installed ~?/~/~
Standpipes~/N)
Depression over Tank
Pumping/Maintenance Contract on File (Y/N)
Holding Tank High-Water Alarm (Y/N) _
Size /~'~¢~' No. of Compartments
Air-tight Caps(~/N) Foundation Cleanout
Date Last Pumpea ~,~,~
~3'¢,/~ for
Temporary Holding Tank Permit (Y/N)
Separation Distances from Sept~c/l(e~.'~Tank
To Water-Supply Well
To Property Line
To Water Main/Service Line
Course
Lc:=, ~,t'
/o¢,
To Building Foundatic- ~"'~/~'
To Disposal Field ~i~ ~
To Stream. Pond, Lake, or Major Drainage
Comments
Page 1 of 2
72-026(11/84)
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Strata
Date Installed '~/~--//~' ~
Width of Field
Square Feet of Absorption Area
Depression over Field (Y~).
Results of Last Adequacy Test
Separation Distance from Absorption Field:
To Water-Supply Well / ~ ~L
To Building Foundation ~-.~' f~
Lot N /,~
~"-~/~ Type of System Design
Length of Field
Depth of Field
Gravel Bed Thickness
Standpipes Present CN)
,~,,//~)~ ate of Last Adequacy Test
To Water Main/Service Line '~'~ '¢
To Stream/Pond/Lake/or Major Drainage Course
To Driveway, Parking Area, or Vehicle Storage Area
To Property Line
To Existing or Abandoned System on
; On Adjoining Lots "~2~
To Cutbank (if present)
Comments
D. LIFT STATION
Date Installed
Dimensions
Size in Gallons
"Pump On" Level at
High Water Alarm Level at
Tested for
Electrical Codes (Y/N)
Manhole/Access (Y/N)
'/~ "Pump Off" Level at
Vent (Y/N)
Pumping Cycles during Adequacy Test. Meets MOA
Comments
** Check Permitted Bedroom Rating Against HAA Request **
I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection.
Date of Payment ~' ¢ ~-~
Amount:
Page 2 of 2
72-026 { 11
MUNICIPALITY OF ANCHORAGE
DIVISION OF ENVIRONMENTAL HEALTH
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
APPLICATION FOR HEALTH AUTtlORITY APPROVAL CERTIFICATE
1. Genera]. Information
Application Date
(a) Legal Depcri_ption (include lot, block, ~ subdivision, section, township, range)
Location (address or, dir~ction~)
7
(b) Applicants Name ~f/~ ~ ~~ Tel=hone- Home Business
(d) Lending Institution
Telephone
Address
(e) Real Estate Co. & Agent
Telephone
(f) the ~ to the ~ollowtng address:
2. Type o~ Residence
Single~Family~
Number of gedrooms
Multi-Family ~---[
Other (describe)
3. Water Suppl_l
Individual Well~
Community
Public
Note: If community well system, must have written cor~firmation from the State
Department of Environmental Conservation attesting to the legality and status.
4. Sewage Disposal_
Onsi~e ~ Public ~-~I
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]
E__~ineeri~g Firm Providin~ !nspe~tions~ 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 w~stewater 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 o~-site ~mter supply and/or wastewater disposal
system is in compliance with all Municipal and State codes, ordinances, and regula-
tions in effect on ~he date of this inspectiou.
Name of Firm
Address
(ENGINEER SEAL)
DHEP
Approved for
Approved __~
bedrooms
Disapproved
Condt t ~ons~
Telephone
Dat~
Temps of Conditional Approval
CAUTION
~HE MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION
(DHEP) ISSUES ltEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT-
ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED
IN TI~ STATE OF ALASKA. THE [)HEP DOES THIS AS A COURTESY TO PURCHASERS OF HOMES AND
THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE-
MENTS. EMPLOYEES OF DHEF DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A
CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS
OR OMISSIONS IN TRE PROFESSIONAL ENGINEER'S WORK~
(DHEP SEAJ.)
RR4/ej/DI$
A®
M£~ICIPALITY OF ANCHOI~AGE (MOA)
HL~&L~{ AUTHORITY APPROVAL (~)
C}~ECKLIST - FI~RUARY 1984
MUNICIPALITY O1: ANCHOP, AG~
DEPT, OF HEALTH &
ENVIRONMENTAl. PROTECTION
.Legal Description: m~
/
Well Classification ~ /~ If A, B, ~ C, D.E.C, ~pro~d(Y~) '
Well ~ ~esent ~te ~,~leted _ ~ ~~.
Total ~p~ /~O Card to ~ ~ ~p~h of Grouting '-~
Static Water ~1 ~ f. __~ ~t At (~
Casing ~ight ~ Gr~nd ~o" Sanit~y ~al on Casing~
Elec~ical Wiring in ~nduit ~Y~) ~ession ~ound ~l~ead (~].
~p~ation Distan~s ~ ~11:
To ~ptic~Ta~ ~ [~t /~O -~ t ~ ~joining Lots
To ~a~st ~ge of ~sorption Field on Lot/~ /~ ; ~ Adjoining ~ts
To ~est ~blic ~r Line _~$ ~/~ _ To ~est ~blic
Clean~t/Ma~ole ~/~ ~ ~a~est ~= ~rvi~ Li~ on ~t
wate~ Sable Collected By3~' ,, ~ ,~ ~.~ ~/~ ~te / ~-- / ~ ~/
Wate~ Sable Test ~sults . ~ ~l j ~ c
/
B. SEPTIC/~TANK DATA
Date Installe_~d y/~ ~ Size /~;~2.O No. of Coi~3cm~t_me, nts
, /-n . / . . ,
Stan~z~s/J~) _ Al=.-tlght Caps((Y~) Foun~tion Cleanout(~
~esslon o~ Ta~ (~ Date ~st,P~d ~f~-~.~
/
Holding Ta~ Hlgn-Wate~ Ala~ (Y~/~ ~r~y Holdirf Tank ~r~t q~)
Sep~ation Distan~s ~ ~ptic~ Tank:
To ~ter ~i~Service Lir~
Course
To Building Foundation
To Disposal Field ~ '
To Stream, Fond, Lake, c~ Major D~ainage
Receipt %
Date Paid
Amount: .~
[Page 1 of 2]
2-15-.84
C. ABSORPTION FIELD DATA
Soils Rating in Absorption Stmata
Date .Installed ~/~__~
Width of Field 30"
Square Feet of Absorption A~ea
aaa
Depression over Field
Results of Last Adequacy Test
Length of Field ~
Depth of Field ~ ~
Thickness 3~
~avel Bed (~
~P Standpipes P~esent
Date of Last Adequacy Test
Separation Distance from Absorption Field:
To ~ater-Supply Well F/~o ~L To P~operty Line /d2 /~z
TO Building Foundation ~ ~ ' ~ To Existing or Abandoned System on
Lot /4_3~ ;~27F~ ; On Adjoining Lots ~ ~J~)~ cJ
To Water ~/Se~vice Line ~ 7z- To Cutbank(if present) ,4_) ~_~-
To Stmeam/Pond/Lake/or Majom D~ainage Course /u~O ~ ~
To D~iveway, Pa~king Amea, or Vehicle Storage A~ea , ~ ~ '~
Con,rents /x~ o ,o .~-
D. LIFT STATION
Date Installed
Size in Gallons
"Pt~ On" Level at
High Weter Alarm Level at
Tested fo~
Electrical Codes(Y/N)
Dimensions
Manhole/Access (Y/N)
'~ ~ff" Level at
/ ~ent (Y/N) '
Pumping Cycles dtming Adequacy Test.
Meets MOA
Cor.~nts
** Check Permitted Bedroom Rating Against HAA Request
I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect
on tb~ date of this inspection. I
Signed Date /~- ~ ~ ~
Company MOA No.
KB1/d5/s
~ ~RB 196~ . - '
[Page 2 of 2]
2-15-84
Properly Owner
rMaill~q, Address
APPLI(' NT FILLS OUT UPPER HAl ONLY
:/~,: :-' :/~d, ~-::__ ~ ~.~: ~,p Code
Address Zip Code
Lending Institution :>'
Realty Co. & Agent
Address
Type of~ldence
L~ngle Family
[] Multiple Family
[] Other
Zip Code
Phone
No. of Bedrooms
Water Su .ply
· [] Community
[] Public Utility
ATTACH WELL LOG. A well Icg is required lor all wells drilled since June 1975.
For wells drilled prior to that date, give well deplh (attach Icg if available).
Sewer Disposal
[] Public Utility
[] Holding Tank
Year IndividuAl Installed: ___ : __
When Connected to Public Utilily:
NOTE: THE INSPECTION EEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED·
Time Time Time Time
Date Date Date Date
Inspector Inspector Inspector Insp~tor
Field Notes:
APPROVED BEDROOMS
DISAPPROVED
CONDITIONAL APPROVAL*
DATE ~_-~4 ~ (~
'CONDITIONS OF APPROVAL
Soils Rating Date Sewer Installed
Well To Absorption Area
Well to Tank
well Log Received Ih ~'~ IL¢~ · --
Septic Tank Size ~0~,~ __
ROBERTA. SHAFER
Now~,mber 16, 1983
CIVIL ENGINEER
694-2979
Municipality of Anchorage
Department of Environmmntal
Conservation
825 L Street
Anchorage, AK 99501
Re: Lot 8: Block 3: Sun Valley subdivision
Dear sir:
A well inspection was performed on the system located on the
referenced property for Disotell Construction. The well casing
was found to be equipped with an adequat. _ e~D~r3~seal and the
wires from~th, e pump_~e~_ge in con~. The ground around the well
'~-~in~ was a~ately sloped away from the well. At the same
time that this-lh-~e--~ion w~ performed, a water sample was taken
from the hose bib on the side of the house and submitted to
Chemical and Geological Laboratories of Alaska for coliforn and
bacteria analysis. The results of this test were satisfactory.
If we may be of
~ R'AS: bg '
further service, please do not hesi,tate t0
SRB 196X EAGLE RIVER, ALASKA 99577