HomeMy WebLinkAboutOLSON HEIGHTS BLK 2 LT 3Olsen Heights
Block 2
Lot 3
#018-231-15
Municipality of Anchorage >*-,
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program, 4700 S. Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650 Page of
www.ci.anchorage.ak.us (907) 343.7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number: S W O O 50 5 PID Number: Qilb- i2lilip
Name'.
Germ Zce_te
Wastewater System: El New Upgrade
Address:
0.0 al -65J41 At -e._
ABSORPTION FIELD
Phone'. Number of ae, drpoms:
,t
jf Deep Trenrn O Shallow Trench O Bed ❑ Mound ❑Other
LEGAL DESCRIPTION
Soil Rating:
/,�
Total Depth from original grade:
P
GPDrFt=
F..
Block: Lot Subtlivision:
Depth to pipe bottom from original grade:
Gravel depth beneath pipe:
Lo' 3 15K 2 0l F_ H 14M 16j H75
gill Ft.
Township. Range: Section
Fill added above original grade:
--
Gravel Length: J
Ft.
Well: New Upgrade
Gravel width:
Number of lines:
Distance between I.nes'.
Ft
FI
Classification (Private, A. 9, C):
Total Depth:
Cased to:
Total ablici area:
Pipe Material:
F€!10 a
�y
l.`
Ft.
Ft.
FIs
303
Driller C_� \
Date OnIled:
Static Water Level:
Ft.
installer.
Date Installed:
/2
Yield.Pump
Sat ac
Casing Height Above Ground:
TANK
GPM
FL
Ft.
SEPARATION
DISTANCES
9KEeptic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
From
Septic
Tank
Absorption
Field
Lift
Station
Holding
Tank
Pubilcipirivate
Sewer Line
Manufacturer.
— -µIG C 01
Capacity.
1 50 Gal.
Material:
Number of Companmen'a
Well
r.
tIJ
!C>
Surface Water
NIC
NIC,
LIFT STA ION
Size:
Manufacwrer
Lot Line
7`6
2-5Gal.
'Pump on levet at:
'Pump oR vel al
High water alarm al'.
Foundation
�^�
'�✓nn
in.
in.
In
Curtain Drain
� 10
N '
Pump Make 8 Model
ecincal Inspedi performed by:
C
Remark'
BENCH MARK
1 1/ �
/e/ '�/
Location and Description: _
k
'e tLt �-r'P
o12
Elevation:
Assumed62
i
�V�, mho°coe5emm®�s�
a.
Inspections performed by: �.. S. Dates: 1s' 54Y -OW ®°m tl0b°°°o09
w.g sp06e . °s eoeecaa°om
2nd y 2y -o'1 a 4obbensiidurmaw
Development Services�,Depart ent Approval
Reviewed and approved by: ii/ . Date:%—/ �. - o
(Rrv. I2/00) <57
c-)
E 135TH, AVENUE i 49th
— — — -- �.�---� .... ........
� 44 so1•'
3 1
_ 2 I
e� I
m
.•
SW/NG TIES
AC 21.5 EC 39 4%
AD 34 8D 43.5
4.9 BE Iii
I11 '$a 1
I I £ --
I I I fndco. I
deck: h m rk I
I H u-elev.- 010011
I11 c :: 1
11 1 0 bt@ T WITH SAND
lY I I p
INSTALE£D N 4 -BEDROOM SYST£Y B
I I 1250 GAL S.
STANDARD CN
Well I GG TT 8 FT Dap 1
11 1 6 TT &ncrm 1
III I
I I
I I o*
Iil 1
JL - - - - - - - - - - - - - - -
25 25 50 7 1w 125 150
SCALE., I' = 51 FT
19 18
TOBBEN STH. AVEN AVfNU£ P.
203 W 15TH. LOT 3 BLOCK 2 OLSEN HEIGHT SfPTiC SWEM AS BUILT
JA CH AK. 99501 GERRY ZE£K DATE: JUNE 8, 2004
907 279-3916 4300 E135TN. AVE SHEET 2/3 GRID: 2936
PERMIT #SW030505 PID # 018-231-15 OLN02032.DWG
Monitor
2' Wlde
60' Long
8' Deep
5' Sewer rock
3' Cover
Founds tion Clean out
ND SCALE
93.6
SIL T
5 Ft of Septic Rock
Cleanouts
Monitor
3' Cover
NO SCALE
0
' � 1
49th
IGEN SPURKLAND
No. CE -2225
4' Min Co
aver—Tor,
BENCH MARK, TOP DECK
' �v 7�
ASSUMED ELEV 100.00
TOBBEN SPURKLAND P.E. 0T 3 BK z OLSEN HEIGHTS S D SEPTIC SYSTEM AS BUILT
An Wrath Ave SEPTIC SYSTEM SCHEMATIC DATE, JUNE 25, 2004
279-2916 1 Anchorage Ak 99501 CARRY ZEa SHEET, 3/3 GRID, 2936
PERMIT No:
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
Permit Number: SW030505
Legal Description:`OLSOhTR
Design Engineer: 0007 Tobben Spurkland, PE
Owner Name: Gerry Zeek
Owner Address: 4300 E 135th Avenue
ANCHORAGE, AK 99511-0644
Date Issued: Dec 17, 2003
Expiration Date: Dec 16, 2004
Parcel ID: 018-231-15
Site Address: 004300 135TH AVE E
Lot Size: 49500 SQ. FT.
Total Bedrooms: 4 Permit Bedrooms: 4
This permit is for the construction of:
❑✓ Disposal Field 0 Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify 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:
Issued By:
Date: //U r�J
Date: G3
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907) 343-7904
ON-SITE SEWERMELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. b IB - „2 31- I ti' Permit Number SW 03503'
Property owner(s) G+QF_ RfL� Z.tfK Day phone
Mailing address (1) Ain k- .O �c
Mailing address (2)
Zip Code 1
Legal description (Lot, Block & Sub'd.) L -o OLSQN 14 1-16it+%5
Legal description (Section, Township & Range) 3� ,f4& Y( A✓t I 1 7 -
Lot Size G -b _Acres
q.Ft.
Number of Bedrooms L4
THIS APPLICATION IS FOR:
Sewer Only
❑
Well Only
❑
Sewer and Well
❑
Water Storage
❑
Sewer Upgrade
THIS PROPERTY CONTAINS:
Hot Tub
❑
Jacuzzi
❑
Swimming Pool
❑
Water Softening Unit
❑
Therapy Pool
❑
I certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorised agent)
i4ea °-=
Permit Fees: Waiver Fees:
Date of Payment: ,L/Ifr it) 3 Date of Payment:
Receipt Number: Y Lc � <Receipt Number:
(Rev. 12100)
T.SPURKLAND P.E.
203 W 15th. Avenue, Suite 203
ANCHORAGE, ALASKA 99501
(907)279-3916
Fax (907)-276-6013
SEPTIC SYSTEM DESIGN
LOT 3 BLOCK 2 OLSEN HEIGHTS S/D
GARRY Z$EK
Municipality of Anchorage December 9, 2003
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 Bragaw Street
Anchorage, Alaska 99519-6650
We are submitting an application for the upgrade of the septic system for this lot. The submittal
consists of three (3) drawings showing the present improvements on the lot and the adjoining
properties, (sheet 1/3), the proposed improvements of the lot, of which only the septic system is
subject to this permit application, (sheet 2/3), and a schematic of the septic system, (sheet 3/3). Soil
logs and percolation tests of applicable test holes are also enclosed. The septic system design is
based on the following:
No Ground Water or Impervious Layer to 15 ft.
Use Standard Trench
Soil Rating. From Testhole 07/12/02
1 mip/in = 1.2 gal per sq.ft/day
No. of Bedrooms 4
Required Area per Bedroom: 150/ 1.2 = 125 sq.ft.
Total area required: 125 x 4 = 500 sgft
Test hole depth 15 feet
Bottom Rock At 8 feet
Top Rock At 3 feet
Rock Depth 5 feet
Minimum Trench Length 500 /10 = 50 ft.
Use 60 ft
SYSTEM CONFIGURATION
STANDARD TRENCH
TOTAL LENGTH
60 FT
TOTAL WIDTH
2 FT
TOTAL DEPTH
8 FT
ROCK DEPTH
5FT
COVER
3FT
SEPTIC TANK
1250 GAL
The installation of this septic system will not prevent wells and septic systems from being installed on the adjacent
lots.
There are no developed or natural surface / sub surface drainage courses on this or the adjacent lots.
The proposed septic system will not change the general slope of the area. Ponding and/or concentration of surface
runoff will not result from this installation.
...........•'
C`�'
i.....;:.... ....I.......... •
TO BEN SPURKLAND' ��I
i 1
NO. CE 225 i
` 51
50 0 50 100 (( 150 200 300
1 I I SCALE, 1 Ck 100 FL 4 1 5
3 � I
I � I
E 135TH, AVENUE
4— — — —
I I 3 I I 5
I III � _•:
WeH
k
I III 5'%`o Y I I
20 I 19 18 17 16
1 I I I
1 I I
BILM LOTSI SEC 21
TOBBEN SPURKLAND P.E. LOT 3 BLOCK 2 OLSEN HEIGHT SEPTIC SYSTEM DESIGN
203 W 15TH.. AVENUE DATE.• DEC. 9, 2003
ANCH. AK. 99501 RY ZEEK
907 279-3916 430000 E133TH. AVE SHEET 1/3 GRID: 2936
PERMIT #SV030XXX PID # 018-231-15 11LH02031,DW6
!Pl
E 135TH. AVENUE i 49th°.
�....... ....... .. �-
-
_
T EN SPURKLAND �'
No. CE-2225
_
I
1
3
1
I
I I
w
1
fi,F
I I i0
fodco.
dec A gidnP.� •.
I I
su :ifs' x00."00 N
III
1
I 1 I
TN
Fl d10 rANK . 'SAND
INSTALL NEW 4-BEDROOM
_ I
III
1250 OAL S.T
_
I I
STANDARD TRENCH
I 1 16
60 FT LONG
Fr DEEP
-
+.:.< `:'.• '.:: 1
Well
11 1
6 FT EFFECTIVE ROCK
1
III
I I
a*
III
1
— — — — — — — —
— — — — — — — _•. — — — -
25 25
50 7
l00 125 150
SCALD I' =
FT,
19
18
T08SEN SPURKLAND P.E.
LOT
3 BLOCK 2 OLSEN HEIGHT
SEPTIC SYSTEM DESIGN
203 W 15TH. AVENUEDATE.•
RY ZEEK
DEC. 9, 2003
ANCH. AK. 99501
430000 E135TH. AVE
SHEET. 2/3 GR/D: 2936
907 279-3916
PERMIT #SV030XXX
PID # 018-231-I5
LlHOP032.DW6
Monitor
°V 1250 gal Sept/c tank
Standard Trenchl
2' Wide
60' Long
8' Deep
6' Sewer rock
3' Cover
Foundat/on Clean out
ND SCALE
SIL T
6 Ft of Septic Rock
Cleanouts
Monitor
3' Cover
NO SCALE
6 Ft
Clean Dut
4' Mln
1250 gal. septic tank
BENCH MARK, TDP DECK
7 ASSUMED ELEV, 100.00
TOBBEN SPURKLAND P.E. OT 3 BK 2 OLSEN HL'iIGHTS S D SEPTIC SYSTEM DESIGN
203 W15th AveDATE, DEC. 15, 2003
Anchorage Ak 99501 SEPT/C SYSTEM SCHEMATIC
9 GARRY Z££K SHEETS $ ;; ,... GRID, 2936
�'�e'
SW030XX
5
Municipality of Anchorage
Development Services Department
Building Safety Division
• .�,�, On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www ci.anchoraoe.ak.us
(907)343-7904
/+ Soils Log - Percolation Test
Performed For: ( Qr,rN Z�C Date.
Legal Description: j c; '3 113y 2 D LSF N 1}k Township, Range, Section:
Depth
M MENTS
nan
WAS GROUNDWATER.
Date
E CCU;ITERED?
hl0
Depth to Water I
5
IF YES, AT WHAT DEPTH?
L
Depth to Water ARer
Monitoring?
0
P
i'r'e% E
Dote:
Reading
Date
Gross Time
Net Time
Depth to Water I
Net Drop
7Qr_
L' e rraf
rOL WJ� ✓AIS
hVl s �V
I
I
�
i
PERCCLATION PATE < f_PEPC HCLE DIAI,IETER
TEST RUQ`; BETWEEN 3_7, AND �4 _FT
PERFORVED By 1 . 1 7. CERTIFY THAT THIS TEST tN S
PERFORMED IN ACCORDANCE WITH ALL STAT E AND MUNICIPAL GUIDELINES IN EFFECT ON THIS DATE DATE r
MUNICIPALITY OF ANCHORAGE
•
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
1
!`,
ENVIRONMENTAL ENGINEERING DIVISION
,
825 L Street - Anchorage, Alaska 99501 Telephone 264-4720
ON-SITE SEWAGE DISPOSAL SYSTEM AND/Oil WELL INSPECTION REPORT
NAME
�^
PHONE
NEW
Gerry Zeek
333-8786
❑ UPGRADE
MAILING
ADDRESS
4314 East 8th Avenue, Anchorage, Alaska
LEGAL DESCRIPTION
Lot 3, Block 2, Olsen Subdivision (Heights)
LOCATION
NO. OF BEDROOMS
Bragaw Street
3
U,4
DISTANCE TO:
Well 106 Feet Absorption area --T—Dwelling
10 Feet
12 Feet
PERMIT NO,
800121
Z
Manufacturer
Material
No. of compartments
ILa
f.,
Greer
Steel
2
n
Liq, capacity in gallons
1 000
IF HOMEMADE:
Inside length
Width
Liquid depth
X
DISTANCE TO:
Well
Dwelling
PERMIT NO.
J02
0z F
Manufacturer
Material
Liquid capacity in gallons
O
Well
Foundation
Nearest lot line
PERMIT NO.
w a
DISTANCE TO:124
EeptFeet
Feet121
LL Z
No. of lines
Length of each line
Total length of lines
Trench width
Distance between lines
F,?W
139
Feint
10inches_
N
To finish
Material beneath the
Total effective
��
of tile to rade,
p g
Screened Gravel
absorption area
p
0
4 - 5 Feet
ail + 79 inches
cn F
Length
Width
Depth
P
PERMI - O.
W
V`
<I-
Type of crib
—
Crib diameter
Crib depth
Total effective absorption area
fl G
W
W
DISTANCE T0:
Well
Building foundation
Nearest lot line
�
Class
Depth
Driller
Distance to lot line
PERMIT N0,
J
W
DISTANCE TO:
Building foundation
Sewer line
Septic tank
Absorption area(s)
OTHER
('ra
PQ
�"n
':��
PIPE MATERIALS
A
Plastic-
SOIL TEST RATING
125
INSTALLER
C & J Excavating
REMARKS
l-st Insp. 5-22-8.0 1LON Noon
2nd Ins p-5-22-80 5-:00 n-m.
L
,,
CR �-f7 ,
a1
50'
t V-
nf,
r?,r c
`A se`s 'N 7 r - ''.•
_
@ F
!�L
`��'
APPROVED e DATE
LEGAL
�®
e
MOENING-GREY & ASSOC., INC. 5-23-80
By:
Alvin R. Zeman
7n_M194 fD,.., 1/1D1
'NAT 3R WELL LOG
BOSS DRILLING ASSOCIATED
909 CHUGACH DR. #37
ANCHORAGE, ALASKA 99503
WELL OWNER Cerry Zeek
WELL LOCATION Lot 3 Block 2
USE OF WELL Domestic
Olson IIeights Subdivision
SIZE OF CASING 6"—DEPTH OF HOLE 40 FT. CASED TO 40 FT.
STATIC WATER LEVEL �5 FT. G, P. Me_ 15 WITH 10 FT. OF DRAWDOWN.
REMARKS
DATE COMPLETED 6/14/80 PUMP TO BE SET AT
.0 to 10
-L0 to 30
_�20 tom
oto 400
to
to
to
to
to
to
to
to
to
to
t0
t0
t0
t0
to
39'
Till brown color and hard____
Alluvium:grey color. medium hardness
fill: Lrey and very hard
Sand and Gravel: trrey, with water
MUNICIPALITY
DEPT. OF I'IR
µ rUION
Irl 11 P-4 I C I F I L_ I" -r 1.11A RD F7 �11%11 V-1 h__ F=11 C3 FEE:
DEPARTMENT OF HEALTH HNr, ENVIRONMENTAL PROTECTION
825 'L' STREET, ANCHORAGE.- HK. 99501
264~4720
1-1 EE IL.- L_ F-11 r,,P U -N !LE'. E"--- 11-11 FEE IF-- F. E I�
PERMIT NO. ( 800121 )
HPPLICRNT GERRY ZEE[-," 4314 E, 8TH HNCH
LOCRTION BRHGRHW AREA `
LEGAL L.T. BLkL2 OUMN'HT5.S/b. LOT SIZE 54000 SQUARE FEET
TYPE OF SOIL ABSORPTION SYSTEM TRENCH
MHXIMUM NUMBER OF BEDROOMS � ] SOIL RATING (SQ FT/BR)- 125
THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS:
����" �"- :1. AZEJ �C'm -T- F-1 :DND �F)'"- %en PF_ L.- ��P'T- 1-1 �-- F5
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 EXCHYHTION (IN FEET).
THERE IS NO SET WIDTH FOR TRENCHES.
THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF QRHVEL BETWEEN THE OUTFALL PIPE
AND THE BOTTOM OF THE EXCHVHTION (IN FEET),
���L�I��� ���_V T� -A'- 1-- ����� ��0� �Fl L.- CH
PERMIT APPLICANT HAS THE RESPONSIBILITY TO INFORM THIS DEPARTMENT DURING THE
INSTHL.LHTION INSPECTIONS OF ANY WELLS F0JH[ENT TO THIS PROPERTY HND THE
NUMBER OF RESIDENCES THAT THE WELL WILL SERVE
�— ---- -r 1,4 C., ��� I 11`1_4 S�; F� E: C_ _117, 1 10 " M:E�* F-1 F� FEE F -a U 'r F:� FE R7_
BACKFILLING OF AN'.? SYSTEM WITHOUT FINAL INSPECTION AND APPROVAL. BY THIS
DEPARTMENT WILL BE SUBJECT TO PROSECUTION.
MINIMUM DISTANCE BETHEEN H WELL HND ANY ON --SITE SEWAGE DISPOSAL. SYSTEM IS
100 FEET FOR H PRIYATE WELL OR 150 TO 200 FEET FROM H PUBLIC WELL DEPENDING
UPON THE TYPE OF PUBLIC WELL
MINIMUM DISTANCE FROM H PRIVATE WELL TO H PRIVATE SEWER LINE IS 25 FEET HND
TO H COMMUNITY SEWER LINE IS 75 FEET.
WELL LOGS ARE REQUIRED AND MUST BE RETURNED TO THE DEPARTMENT WITHIN 30 DAYS
OF THE WELL COMPLETION
OTHER RE-D8UIREMENTS MHY HPPL\! SPECIFICATIONS, HN[ CONSTRUCTION DIAGRAMS FIRE
HVHILHBIX TO INSURE PROPER INSTALLATION.
������ F` 1 R`! IIE! =-- ' l_^
I CERTIFY THAT
1: I AM FAMILIAR WITH THE REQUIREMENTS FOR ON_SITE 'l --.EWERS
FORTH BY THE MUNICIPALITY OF ANCHORAGE.
2: I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES.
3� I UNDERSTAND THAT THE 8N -SITE SEWER SYSTEM MHY REQUIRE
RE5IDENCE IS REMQDELE[,_�f[)AINCLUDE MORE THAN ] BEDROOMS.
SI
ISSUED BY
AND WELLS HS SET
ENLHRGEMENT IF THE
X SOILS LOG
-� MUNICIPALITY OF ANCHORAGE
DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 11 PERCOLATION
TEST
Pouch 6.650, Anchorage, Alaska 99502 276-2221
SOILS LOG - PERCOLATION TEST
PERFORMED FOR:
72-008 (7/76)
WAS GROUND WATER /j -
ENCOUNTERED? V
IF YES, AT WHAT
DEPTH?
DATE PERFORMED:
Reading
Date
Gross
Time
Net
Time
Depth to
Water
Net
Drop
PERCOLATION RATE
TEST RUN BETWEEN
��Q��OF'C5510�P�9
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak. us
(907) 343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel I.D. _ 0 !�, � l> HAA #.1.
`3 v
1. GENERAL INFORMATION
Expiration Date: 0 - -O �r
- -
Complete legal description i- 6 i 3 T; (L 2 O� LE L( )j b✓ l 61 _
Location (site address or directions) gaexo f= 13 1-6 /i- ,/e -
Current Property owner(s) le ,^ V- y Zee_ ll-- Day phone
Mailing address _P_ 0, "5 4 I i c tCL i{ Ai i 4
Lending agency
Mailing address
Day phone
Real Estate Agent Day phone SS 2 I Z—
Mailing Address rwo✓�rA
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
d l
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
je.
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 Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Health Authority 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. 1 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 1 6 `� � � i6 r �'° xkoe 7 Phone a2 z.— sq
Address
Engineer's Printed Name
5, DSD SIGNATURE
Approved for 14 bedrooms.
Conditional approval for bedrooms, with the following stipulations:
Additional Comments
Note: The well for this property meets existing State and Municipal Codes. There are nitrates
present. It is suggested that periodic testing be performed to insure the wells continued suitability.
Current nitrate concentration is 5.87 mg/1. EPA maximum concentration is 10.0 mg/1. More
information on nitrates is available from the On -Site Services Program, at 343-7904.
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other
By: m, Original Certificate Date: 7— Z a - o
(Rev. 01102)
Municipality of Anchorage
� e
Development ServiIles Department
Y i
P Al
Building Safety proision `
On -_Site Water &wastewater Pram s ^ F T Y
40 ou ra aw
ox 6 0" nc orage AK 95'19-6
i'anchorege ak us
,z -+e_"4, Ax'W# •xa � vim%• N _
''t 3 EALTH AUTHOI APPROVAL CHECKLf T
ParcellD 1718 3f /�
+mow, x+ - ��a. '�.• ,�}w�.x"�t..c".�'.'r,.S e-�.�:wr a�..^`;,c.'-e F..,,..,
If A B or C provide PWSID # Well Log (Y/N)
fitex' F" " � `*. +, v�iuXn Zu' • +a,;.7n+.ixa,nw s., m: m s an rttaa'dm II L .. ..
eteditzfR&✓ Sanitaryseal'(Y/N) Wires properly protected (Y/N),
0 ft Cased to 0 + ft. Casing height (above ground) 12 in
a a
R L G AT INSpECT12i14`
CtIOn' '" • +rvr w :s r . .wax . 4. mwe. ctm rau ., ... - .
colonies/100 MI,Nitrate 5g 7 mg./I. Other bacteria colonies/100 ml.
Date of sample: 1 %/j A Collected by
.. i� a 'i�A;�,ef"£3'!�'�`d`�+R�✓`w`4�"�'"`°'e'��t �nkietw"�«wn: '`��,r6yk °zt n+.u's!"a,zlp.,� � re �'.:..
Aatera 'c S�.ei,,( ,�„„„„ ,� Datemstalled �/91i/o��
e,-
gar Number of Compa'rfinenfs .2 Cleanouts (Y/N)
;learrout (Y/N) Depression over tank (Y/N) N High water alarm_(Y/N) t�, 1
Ping ` N Pumper:. i✓
roT ,
d s/�y SoU rating (g p d /ft2 orft2/bdrm) z .System type
ft Width ft. 'Gravel belowpipe 5 ft.
8 ft ,„�+ Eff. absorption area ft2 Mo itormg tube Depression over field N
uacytest�- Resufts(pas5/Faitf For bedrooms
i a)isnrpt�o�nfiel""d b e tes�m.yyt�er added mal New depth ✓ in. .
_mm Final,fluid_deptfi" ✓m• Absorptwn rate > 6 P�fl g p d
tion ti•eafinent (past'I�inio') tYPe h. _._ _._..._LL� (f ves nioa riaro .�'
C) Wells on adjacent lots ICU'
systems are in
effect on this date.
Date of Payment
Receipt Number
!Z -<c^.-02: 4:38PM;
:909 56,530, u i
lThankyem
QGQ
200
Drinking Water Analysis Report for Total Coliform Bacteria TAm
READ INSTB UCTIONS ON REVERSE SIDE BEFORE COLLECTING SAMPLE Fax;
❑ PUBLIC WATER SYSTEM I.D. 0
e�, PRIVATE WATER SYSTEM
❑ Send Results
❑
Sendlnvolee
as ye¢m ame�ni
a �n
woe
�i—ta>< —
PFvne vm et
Data
e—R m5ei
Add.
"
SIM 4, Cod.
❑ Send Results ❑ Send Invoice
omxnv ume woe
.y SIM Zi,
SAMPLE DATE: FrUl FIT F&
Month Day Year
SAMPLE TYPE:
Routine
❑ - Repeat Sample (for routine sample
with lab ref. no. )
(3 Special Purpose
SAMPLE LOCATION
3%Z aGsN
❑ Treated Wale.
Untreated Water
Time
Collected
ll:uL)
Potter Drive
ige, AK 99518-1605
Analysis shows this Water SAMPLE to be:
)j' Satisfactory
❑ Unsatisfactory
❑ Sample over 30 hours old, results may
be unreliable
❑ Sample too lon�gg in transit; sample should
not be ove3lGhours old at examination
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received I'Z'f'P-W-3
Time Received -- M -co
Analysis Began (SM
Analytical Method: 9C Membrane Filter
❑ MMO-MUG
• Number of colonies/1 00 nil.
Result* Analyst
1037970 -1/
1111111111111
Collected
By
1.s
Please Pdnl
LSIZJ c_
knch Fbks Jun ❑
Faxed
Date:
Time:
Client notified of unsatisfactory results;
❑
❑
Phoned
Spoke with Faxed
Data
Time: _
BACTERIOLOGICAL WATER ANALYSIS RECORD
MMO-MUG Result: Total Coliform E. CoR
Membrane Filter: Direct Count Colonies/100 ml
Verificatlow LTB _ F.GB __ COLIFIRM TNTC- ro.rmw...Ii.r.C...e
Fecal ColiformConfiroatlon OR -orheraocw'.
Final Membranes Filter Results , 411i4 L[& 1224 Coliform/l00 ml
Reported By !S2.dic'nor Date , f Time t. 17.7!_1 hrs
Comments: �� ((!!
r:
CTMEVironmental Services Inc. 290Wast Porter Oriw,Anchorage,AK99519-1605 t(9071562.2343 1(907)561.5301 wwwsgsennronmental.xm
-�` —' y 4 Nemb.r vlthe SOS OMD(Sxihd Sdndnle de eiNeillmee)
12-11-83 03:49P8 'FROIFCT&E ESI, NS EBV SERVICES 9075E15381 T-821 P.02/03 F-589
SGS'
SGS ReU
1037810001
Client Name
Tobben Spuddand P.E.
Project Nomag
32 Olsen Heiltht
Client Samek W
32 Olsen Height
Matrix
Dtinking Water
Sample Rerwkc:
Ali DatWnmes are Alaska Standard Time
Printed Date/Time 12/11/2003 12:44
Colleeted Dotamme 12/08!2003 14:15
Received DatWThne 12/08/2003 14:35
Technical Director //Sttee/ppheeenC.Ede
Released�d A
Allowable Prep Analysis
Parameter Resntn PQL units Medmd Comainm ID Limit Ik[e Dae [nit
Motors Department
Nitmte•N 5.87 0.100 MWL EPA 300.0 B (r-10)
Microbiology Laboratory
Total Coliform 503,W/PecalCob col/100mL SM199222B A (<-1)
12)0&03 JJB
12/08/03 DKC
12-11-03 03:49PM FROM-CTAE ESI, SGS ENV SERVICES 9075015301 T-821 P.03/03 F-589
1 PAID
Thank you
Drinking Water Analysis Report for Total Coliform Bacteria T
READINSTRUCTIONSONREVERSE SIDEREPORECOLLECTING SAMPLE Fax
❑ PUBLIC WATER SYSTEM I.A. #FT -77 TTI
PRIVATE WATER SYSTEM
D Send Reaula
�^V �•�e• _ �� 1
waar
nwna mmtnrne
,yna ypIre,
Nufter
Mw ,y
city
am
❑ Send Rexnln ❑ Sead lnralce
wnmea enm loam
My a P wk
SAMPLE DATE: Ey
Month Day Year
SA LE TYPE:
Routine
❑ Repeat Sample (for routine sample
with lab ret. no. )
❑ Special Purpose
SAMPLE LOCATION
�Vi- 04 S3-f"i
❑ Treated Water
�y Untreated Water
Time Collected
Collected By
Please Pred
W. Potter Drive
ionme, AK 99518-1605
Analysis shows this Water SAMPLE to be:
❑ Satisfactory
K Unsatisfactory
❑ Sample over 30 hours old. results may
be unreliable
❑ Sample too long in transit; sample should
not be over3lMours old at exammatiun
to indicate reliable results. Please send
new sample via special delivery mail.
Date Received )' -go%
Time Received 1175
Analysis Began rs6P
Au#lytIcaI Method: R Membrane Filter
❑ MMO-MIJG
9 ml.
Result* Analyst
10378:10 /�-
w� peal eol Xe
Sent to A.D.B.C. Aach Fbke Jun ❑
Faced
Dale: Tirm
Client notified of unsatisfactory results:
❑ R
Phoncel Spoke with Faxed
Date; ta_ 4p� Tame: 1545
BACTERIOLOGICAL WATER ANALYSIS RECORMeid For Confirmation
MMO-MUG Result: Total Culfibrm E. Coll
Membrane Filter: Direct Count 09,4 1 001. C� .i_ Culonies1100 rat
Verification: LTB IpA4f' BGB _ ° ' COLIFIRM 'wire= Too A'moeraa To Cower
Fecal Collform Confirmation {_ • [ na =odw. aw4r,id
Final Membrane Filter
kkk�Results {idvs }j gtl—Qf� Coliforml100ml
Reported By C/ Date 11it„Time_15ii hrs
Comments: — �J
Ci it incnonnmilsi 5eo�ln-;Inv 200 West Potter O_rive, Ardvraae, AK 99518-1005 t{9071582-2343 f19071561-5301 w .e3semirolrneiolxam
`Memh Diem 935 Gm; igmkt Gen4un de&miraneel
-Z-
- l9 -
SCALE
I"- 30'
G'
626ir
/35 fA AyE .
in
M1I
N9y"5300'E
Rec4vliii ed 6-/j -O¢��(/
AS -BUILT NO CORNERS SET THIS DATE
I heroby certify that i have Performed a Mortgagee's inspection
of the following tleecribed properly: o T 29,
kir' F, (��n,�. eh.
2 _L5 H'
SON L f N1.- 9URo-
ayY y±;
Anchorage Recording Precinct, Alaska, antl that the
and
r�R .1
improvements situated thereon are within the lines and
do not overlap
„4
or encroach on the property lying adjacent
thereto,
that cc!mprevemente on property lying atljacent thereto
encro.ch on the premises in question and that there are no
reatlways, transmission lines or other visible easements on nud
• L ,�44 b k " �.
properly etmept as indicated hereon.
Dated al Anchorage, Alaska
EASEMENTS OF RECORD, OTHER THAN
this
THOSE SHOWN ON THE RECORDED rb 3 O„
FRED WALATlkA B ASSOCIATES
PLAT ARE NOT SHOWN HEREON. Pd. i�7 gE
(90])245-1666 Engineers and Surveyors
TS.
Municipality of Anchorage O
at B
• Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
CERTIFICATE OF HEALTH AUTHORITY APPROVAL
FOR A SINGLE FAMILY DWELLING
Parcel 1. D. 01A— A31- 15 HAA # n�0�"I
Expiration Date: %
1. GENERAL INFORMATION
Complete legal description ' Lo 7 3 f R><2 Ot_SAnt "Et+C14fil
Location (site address or directions)
3D-0 E. 13y 1-4 Ave
Current Property owner(s) iakye__1
-Z- F_ Ptd Day phone
Mailing address ���i�i,�
G��� Qq I
Lending agency
Day phone
Mailing address
Real Estate Agent S
Sxg/iia
LS '�Vt'/ Dayphone
Mailing Address
Unless otherwise requested, HAA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS:
3. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual On-site
21*0
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 Health Authority
Approval (HAA) based only upon the representations given in paragraph 4 by an independent professional civil
engineer registered in the State of Alaska. Certificates of Health Authority 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 HAAs upon request to homeowners. Certificates of Health Authority 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 Health Authority 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 o bbe_tj SCVrk1*.me C Phone '9-74-341,6
Address
ti
Engineer's Printed NameI ot.L,ctj 9eurk.L4LKV
5. DSD SIGNATURE
Approved for bedrooms.
Disapproved.
XX Conditional approval for 4 bedrooms, with the following stipulations:
Money in the amount of 1.5 times the high bid of a minimum of three bids from approved
contractors shall be put in escrow to construct a new wastewater disposal system pursuant
to permit number SW030505 attached. Money in escrow shall not be released until this
office has given final approval. Construction shall be completed no later than June 15, 2004.
Additional Comments Note: The well for this property meets existing State and
be performed to insure the wells continued suitability. Current nitrate concentration
is 5.87 mg/1. EPA maximum concentration is 10.0 mg/l. More"information on nitrates
is available from the On—Site Services Program, at 343-7904.
Attachments:
HAA Checklist X Maintenance Agreements
Septic System Advisory Supplemental Engineer's Report
Well Flow Advisory Other W19,57E1. ATF_ R C0N5'7'IRM477aiv
By. Original Certificate Date: Iz I % LOY
(Rev. 01ro2)
Municipality of Anchorage
Development Services Department
Building Safety Division <
On-Site Water & Wastewater Program `*
4700 South Bragaw St.
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
HEALTH AUTHORITY APPROVAL CHECKLIST
Legal Description: Lo T 3; (31/� 2 O LS k' I,I N>=_tG, H i Parcel ID: 18 -231- I
A. WELL DATA
Well type ` . If A, B, or C provide PWSID # lq/,N Well Log (YIN) N
Date completed ? Sanitary seal (Y/N) _;�e Wires properly protected (Y/N)_
Total depth Z ft. Cased to y0� ft. Casing height (above ground) 12. in.
FROM WELL LOG AT INSPECTION
Date of test I
i
Static'water level ft.
Well production g.p.m. g.p.m.
WATER SAMPLE RESULTS:
Coliform colonies/100 mL Nitrate S 7 Mg./I. Other bacteria 5 colonies/100 ml.
Arsenic: mg./I. Date of sample:; Collected by: t S!'v r V-k& q,0(
B. SEPTICIHOLDING TANK DATA ���{` 1 tl��o-'S C_C It-
i.
Tank Type/Material5�` S� e-e� Date installed
Tank size Moo o gal. Number of Compartments ,2 Cleanouts (Y/N)
Foundation cleanout (Y/N) Depression over tank (Y/N) 1� High water alarm (Y/N) lam)
Date of pum1ping NSA Pumper 1y1A 1 6e-
C.
eC. ABSORPTION FIELD DATA
Date installed 5-R 3-8v Soil rating (g.p.d./ft2 orft2/bdrm) 1_ System type 1 raHc L,
Length' ;39 ft. Width 5 ft. Gravel below pipe 6 ft.
Total depth 12 t ft. Eff. absorption area y6ft' Monitoring tube %, Depression over field I`1
Date of adequacy test I Z 181,03 Results (Pass/Fail) I- For 3 bedrooms
Fluid depth in absorption field before test in. Water added_ gal.
Elapsed Time: —min. Final fluid depth_ in. Absorption rate >=
Any rejuvenation treatment (past 12 mo.) (Y/N & type)
New depth_ in.
If yes, give date
...
D. LIFT STATION
Date installed ize in gallons
"Pump on" level at —Z
in. "Pump off" level at in.
Datum Cycles tested
E. SEPARATION DISTANCES
SEPARATION DISTANCES FROM WELL ON LOT TO:
Septic tank/lift station on lot 160
Absorption field on lot tots +
Public sewer main N�j�,
Manhole/Access (Y/
High water ala level at in.
Meets ala & circuit requirements?
On adjacent lots `100
On adjacent lots 1 v a -i
Public sewer manhole/cleanout V_Y/A
Sewer /septic service line 1 v O Holding tank
SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO:
Building foundation I Property line b0 Absorption field ;25
Water main ~/A Water service line t Surface water t4lo
Wells on adjacent lots
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line 5 O Building foundation I Water main "A
Water Service line rp 4- Surface water t`110 Driveway, parking/vehicle storage o
Curtain drain N o Wells on adjacent lots f
F. COMMENTS
14!S i J: M Iii I L_L T3 IF Z1�:-P LALLz
G. ENGINEER'S CERTIFICATION
I certify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA HAA guidelines in effect on this date.
Engineer's Printed Name obloeK �nv r1Llc�
Date ' e- 17 Zoo 3
HAA Fee $ 3 7 b
Date of Payment z/ �� 3
Receipt Number Y 6 ;Q 3W C
(Rev. 12/01)
;nom
Waiver Fee $
Date of Payment
Receipt Number
r E,
9.
;nom
Waiver Fee $
Date of Payment
Receipt Number
r E,
'RRP R
DATE RECEIVED
INSPECTION APPOINTMENTS
Czs el_ _ 6ee( -
TIME -
TIME -
TIME
CA (' A P An ��•
DATE
DATE
DATE-
SINGLE FAMILY
—
0 Two 0 Five
>�
INSPECTOR INSPECTOR INSPECTOR
- MUas QP ^�Q eF hldCtfORfc@
MUNICIPALITY OF ANCHORAGE DEPL OF HEALTH &
IRUNMENTAL PROTECTION
DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION
825 L Street - Anchorage, Alaska 99501
• SEP 91950
ENVIRONMENTAL SANITATION DIVISION
Telephone 264.4720 RECEIVED
REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES
DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten 00) days for processing.
1. PROPERTY OWNER
C. -C1
PHONE
F 7S4<
v r'l .
l � _YEAR ON-SITE SYSTEM WAS INSTALLED.
MAI LING ADDRESS /) i
d 'wl, Jln
PROPERTY RESIDENT (If different from above) - � PHONE
C/.`-0 I OCC c� 0/S` rVC� GU
2. BUYER PHONE
MAILING ADDRESS. - -
3. LENDING INSTITUTION HONE -
'•���f''��-'-,
MAILING ADDRESS
a e AIOLAV,1i 4-r L� 0/2 AAW
4. ENT s
�tt A/u r> lCCh A711 b011111-1 (),M7
PHONE
MAILING ADDRESS -
ar�r
5. LEGAL DESCRIPTION
®!
Lo 1 Xlc D,
Czs el_ _ 6ee( -
STREET LOCATION
-
6. TYPE F RESIDENCE
NUMBER OF�BEDROOMS
O One C7 Four ❑ Other
SINGLE FAMILY
—
0 Two 0 Five
O MULTIPLE FAMILY
Three E:1 Six
7. WATER SUPPLY
INDIVIDUAL*
* ATTACH WELL LOG. A well lag is required for all wells drilled
COMMUNITY
since June 1975. For wells drilled prior to that date, give well
ED PUBLIC UTILITY
depth (attach log if available.)
8. SEWAGE DISPOSAL SYSTEM
[l INDIVIDUAL/ON-SITE**
l � _YEAR ON-SITE SYSTEM WAS INSTALLED.
El PUBLIC UTILITY
NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED.
72-010 (Rev. 6/79) -
+ C�'
"-nin lR.,. a/791
THIS SIDE FOR OFFICIAL USE ONLY
1. TYPE OF RESIDENCE
w
NUMBER OF BEDROOMS
❑ SINGLE FAMILY
❑ ONE
❑ THREE
❑ FIVE ❑ OTHER
❑ MULTIPLE FAMILY
❑ TWO
❑ FOUR
❑ SIX
Z. WATER SUPPLY
PERMIT NUMBER
❑ INDIVIDUAL
DEPTH OF WELL
❑ COMMUNITY
DATE DRILLED
❑ PUBLIC UTILITY
Connection Verified
LOG RECEIVED
3. SEWAGE DISPOSAL SYSTEM
PERMIT NUMBER
❑INDIVIDUAL/ON -SITE
DATE INSTALLED
❑PUBLIC UTILITY
Connection Verified
INSTALLER
`
❑Septic Tank or ❑ Holding Tank
Size: 000 If Tank is homemade
SOILS RATING
give dimensions:
TYPE OF TANK
MANUFACTURER
�J
TOTAL ABSORPTION AREA
-
MATERIAL
4. DISTANCES
Septic/Holding Tank
Absorption Area
Sewer Line
Nearest Lot Line
WELL TO:
Absorption Area to nearest Lot Line
5. COMMENTS
APPROVED FOR BEDROOMS
CONDITIONAL APPROVAL
(letter must accompany certificate)
❑ DISAPPROVED
DATE
q
BY
"-nin lR.,. a/791