HomeMy WebLinkAboutPENNINGTON PARK BLK 4 LT 1PENNINGTON Block 4 Lot 1 020 - 181 - 20 Municipality of Anchorage e 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 Page 1 of 3 On-Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SW040202 PID Number: 020-181-34 Name: TOM & CHIRS FARRINGTON Wastewater System: ❑ New ■ Upgrade Address: 17330 BETTI JEAN ROAD * ANCHORAGE, AK 99516 ABSORPTION FIELD Phone: No. of Bedrooms: (907) 345-2618 3 O Deep Trench O Shollow Trench ■ Bed ❑Mound 11 Other LEGAL DESCRIPTION Soil Rating: 0 5 Total Depth from *SEE grade: GPD/Sq R DWG. FL Block: Lot Subdivision: Depth to pipe bottom from original gradr. Gravel depth beneath pipe: 4 1 PENNINGTON PARK SEE DWG. 0.5 Ft. R, Township: Range: Section: Fill added above anginal grade: Gravel length: SEE DWG. Ft. 43-51 Ft. WELL: ❑ New ❑ Upgrade Gravel width: 18-25 Number of lima: 7 Distance bebreen lines VARIES Ft. F. Classfficalion (Privote, A,R,a): Cased To: Total obsorpean area: Pipe material: -( {�� Fl. 1000+ SD. Ft. D 3034/ F-810 Driller. �/ `S `,t `� Static Water Level: Installer: Dote installed: GEG, Ltd. 6/28-29/2004 Ft. _ _ Web: Pump Set At:Casing Height Above Ground: -- - Ft. TANK GPM n. SEPARATION DISTANCES 0Septic ❑Holding 0S.T.E.P. T1NG Other Manufacturer. TO Septic Absorption Lift I Holding Public/Private From Tank Field Station Tank Sewer Lines Well 100'+ 100'+ — — 25'+ Material: Number of compartments: Surface Water 100'+ too'+ — — — LIFT STATION Lot Line 5'+ 10'+ — — — Size in gallons: Manufacturwr. Foundation 5'+ 10,+ — — — "Pump on" level at "Pump off" at: High water alarm at: Curtain Drain NONE KNOWN Pump Noke eb Electrical Inspections performed by. Remarks: BENCH MARK Location and Description: *LIMITED TO REMOVAL OF CONTAMINATED MATERIAL TOP OF GARAGE SLAB AND RE—INSTALLATION AT SAME GRADE OR HIGHER. EXISTING TANK EXCAVATED AND INTEGRITY VERIFIED. Assumed Elevation: 100.00 Fl. ENGINEER'S Inspections performed by: GEG, Ltd. Dates: 1st 6/28/2004* :, q T 71 2nd 6/28/2004 3rd 6/28/2004 4th 6/29/2004 f e A. Gar ess:' X009. Development Department Approval ' .. c —7 3 ..�p� fpeaP. Vrv,es Reviewed and approved by:Date: ' 3 -O (Rev. 12/01) O� rofessloO a �O�o�o PERMIT NUMBER: AS —BUILT DRAWING PARCEL ID NUMBER: SW040202 020-181-34 I APPROXIMATE STREAM LOCATION / STS � / I I i � I f APPROXIMATELOCATf STRAMISETBACK , I { EXISTING / WELL t. EXISTING 1000 _ r �OG GALLON SEPTIC TANK FOO•!7 I � / I S&S ENG. �{ TH#4 A B \ FCO 21.94 25.33 MZ•L ' !' / %` �' 5T1 26.03 32.39 5T2 30.74 '3 DBLI 32.68 39.20 DBL2 33.47 39.99 Opl C01 94.84 95.58 p06 //, CO2 91.58 93.95 Cp51 ��,F-� / CO3 86.93 91.72 C04 132.95 140.14 00 i ,o J'(XV� C05 128.86 137.76 �. C06 122.02 133.66 s C07 119.44 132.30 / MT7 94.95 95.55 ('� / MT2 84.88 90.93 ` MT3 134.46141.65 MT4 117.6 130.74 ATE: oo6p0� - 6/29/2004 _o pF p0 ' S�oOP DRAWN SY: GA.RNESS ENGINEERING GROUP, Ltd. A.J.G. Q���........... arm: SCALE: 1 „ 4D' CONSULTANTS & GENERAL CONTRACTORS 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 . PHONE (907)337-6179 * FAX (907)338246 T y � � ' •' •"• ' • �'?? O D PREPARED FOR: PHONE NUMBER: PAGE NUMBER: TOM & CHRIS FARRINGTON 345-2618 2 OF 3 0 y � G•rn •arn ss: � LEGAL DESCRIPTION: E 79 •' c��O (� PENNINGTON PARK SUBDIVISION; LOT 1, BLOCK 4, pPdF'od TYPE OF WORK: AS—BUILT DRAWING OF SEPTIC SYSTEM UPGRADE pp00000\ PERMIT NUMBER: SW040202 NOTE: INSTALLATION LIMITED TO REMOVAL OF CONTAMINATED MATERIAL AND RE -INSTALLATION AT SAME GRADE OR HIGHER THAN ORIGINAL DRAINFIELD FINAL GRADE _ 92.87-93.31 TOP OF SAND = 88.60 — 18'-25' WIDE BOTTOM OF EXCAVATION = 87.38-88.28 — INSULATION —FILTER FABRIC 6/29/2004 DRAWN BY: GARNESS ENGINEERING GROUP, Ltd. =GALE: A.�.c. CONSULTANTS & GENERAL CONTRACTORS 1 " = 40' 3701 E. TUDOR ROAD, SUITE 101 . ANCHORAGE. AK 99507 • PHONE (907)337-6179' FAX (907)338-3246 IREPARED FOR: PHONE NUMBER: PAGE NUMBER: TOM & CHRIS FARRINGTON 345-2618 3 OF 3 .EGAL DESCRIPTION: PENNINGTON PARK SUBDIVISION; LOT 1, BLOCK 4, YPE OF WORK: PROFILE AS -BUILT DRAWING OF SEPTIC SYSTEM UPGRADE PARCEL ID NUMBER: 020-181-34 (VERT OF DISTRIBUTION LINE - 89.10 (AVG.) 44 Permit Number: SW040202 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 Initial Legal Description: T", NIN TON PARK BILK 1 LT 4 f Design Engineer: 0855 Garness Engineering Group, LTD Owner Name: tom farrington Owner Address: PO Box 231753 ANCHORAGE, AK 99523-0000 �'yj&I L I - Date Issued: Jun 17, 2004 Expiration Date: Jun 17, 2005 Parcel ID: 020-181-34 Site Address: 017425 BETTIJEAN ST Lot Size: 43314 SQ. FT. Total Bedrooms: 3 Permit Bedrooms: 3 This permit is for the construction of: 0 Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy All construction must be in accordance with: 1. The attached approved design. ❑ Private Well ❑ Water Storage 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: Date: 4AV/011 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 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 6 Zo Permit Number Property owner(s) CHRIS & TOM FARRINGTON Day phone 345-2618 Mailing address (1) 17330 BETTIJEAN STREET * ANCHORAGE. AK Mailing address (2) Zip Code 99516 Legal description (Lot, Block & Sub'd.) LOT 4. BLOCK 1: PENNINGTON PARK SUBDIVISION Legal description (Section, Township & Range) N/A Lot Size 12/ 4 ?t`i Acre PNumber of Bedrooms THIS APPLICATION IS FOR: Sewer Only ❑ Well Only ❑ Sewer and Well ❑ Water Storage ❑ Sewer Upgrade E 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. GARNESS ENGINEERING GROUP, Ltd. Permit Fees:_ (0 Waiver Fees: Date of Payment: 0 Date of Payment: Receipt Number: Receipt Number:. GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS June 15, 2004 Municipality of Anchorage Development Service Department On -Site Water & Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, Ak 99519-6650 (907)343-7904 Ref: Septic Design for Pennington Park Subdivision; Lot 1, Block 4, To whom it may concern: The existing 3 bedroom house is served by a private well and septic system. The drainfield is in the state of failure and needs to be upgraded. Due to the limited area for a septic system upgrade, we are proposing to rebuild the existing bed. A test hole was performed by S&S engineering on 7/7/1992. We are proposing to excavate and remove all contaminated material from the existing bed and rebuild it to the existing or higher elevation. We are also proposing to excavate the existing 1000 gallon septic tank to verify its integrity. If the tank integrity is found to be poor, we will install a new 1000 gallon septic tank will be installed. Comments regarding the design are summarized as follows: 1. SOILS: Attached is a log, which shows the soil classifications, groundwater monitoring, and the percolation test results. 2. BED DESIGN: a. Percolation Rate: 10 minutes/inch b. Allowable Application Rate: 0.5 gallons/day/ft2 c. Design Flow: 450 gallons per day d. Minimum Absorption Area: 900 fe e. Total Depth: Removal of all contaminated material f. Effective Depth: 0.5 feet g. Width: 18-25 feet h. Minimum Length: 51 feet long i. M.O.A. approved sand filter: As required be at or higher than existing sand elevation. j. Effective absorption area = 1096 ft 3. SURFACE WATERS: There is a stream 100 feet plus from the proposed septic system upgrade running northeast to southwest on the north end of the lot. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: garnessengineering.com 4. TOPOGRAPHY: As can be seen on the attached topo drawing, the proposed drainfield is to be installed on a 5 tol0 percent slope, running approximately east to west. I am unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If yo have any questions, please contact us at 337-6179. Thank you for your assistance. P.E., M.S. NOTE: Attached is a site plan drawing, a design drawing, a topography site plan, a soil log, and a 7 page construction specification letter which are all part of the design package for this septic system. 3701 E. Tudor Road, Suite 101 * Anchorage, AK 99507 Ph: (907) 337-6179 * Fax: (907) 338-3246 * Website: gamessengineering.com 0 W m V) Z EXISTING 3 SEDR00 EXISTING SEPTIC f j I i ARPTICE ...7 I _.�, ggplils j i 11 PENNINGTON PARK S/D; LOT 7A, BLOCK 1, �\ SEPTIC \\ \\ ARS \ \ 'P LOT 3ON PARK S/D; \ LOT 3A, BLOCK 1, \ I LOCATION 1 f1 t \� AREA- PENNINGTON I It•�� t i \� I ii ` r t1 j PENNINGTON PARK S/D; LOT 4A, BLOCK 1, PENNINGTON PARK S/D; L�O-T+-2, BLOCK 4, `-5 PTIC I i � PENNINGTON PARK S/D;- LOT 3, BLOCK 4, GARNESS ENGINEERING GROUP, Ltd. CONSULTANTS & GENERAL CONTRACTORS PARED FOR PHONE NUMBER: CHRIS & TOM FARRINGTON 345-2618 N_ DESCRIPTION: PENNINGTON PARK SUBDIVISION; LOT 1, BLOCK 4, OF WORK: SITE PLAN FOR SEPTIC SYSTEM UPGRADE I! C.J.G. 1" = too' I9 ...... i ... r.lVL... i......... 1 OF 2 I -- APPROXIMATE STREAM LOCATION I _NOT' THE CONTRACTOR SHALL I HAVE THE WEST AND SOUTH LOT LINE AND UTILITY EASEMENT I I I FLAGGED PRIOR I APPROXIMATE LOCATION OF STREAM SETBA( I I wl �I S&S ENG. �F TH#4 oI N. IXISTING I WELL O 1 1 J / `EXISTING BED TO BE REBUILT. ALL / CONTAMINATED MATERIAL IS TO BE REMOVED AND TO BE REBUILT TO EXISTING OR HIGHER ELEVATIONS. I r / INSTALL FOUNDATION GARNESS ENGINEERING GROUP, Ltd CONSULTANTS & GENERAL CONTRACTORS 3701 E. TUDOR ROAD. SUITE IOI' ANCHORAGE, AK 99507' PHONE (907)337-6179' FAX (907)338-3246 —EXISTING 1000 GALLON SEPTIC TANK TO BE EXCAVATED AND THE INTEGRITY VERIFIED. IF OF POOR INTEGRITY A NEW 1000 GALLON / SEPTIC TANK TO BE INSTALLED/ INSTALL DOUBLE i CLEANOUTS / 6/15/2004 0 F DRAWN BY: C.J.G. SCALE: Opp`. 4 T �, 1 » = 40, ......... . ............ PREPARED FOR: PHONE NUMBER:rAGt NUMtltrc: CHRIS & TOM FARRINGTON 345-2618 1 OF 2 K r oGrnSs:LEGAL DESCRIPTION: pp7'`�o� PENNINGTON PARK SUBDIVISION; LOT 1, BLOCK 4, TYPE OF WORK: 44vOea p+'ofessio�oc>`��o DESIGN FOR PROPOSED SEPTIC SYSTEM UPGRADE �pppppoo U 3 0 OW' M AD ININGTgN PARK S LOT 2,I8LOCK 4, 4, ( eo S/D; 1, 4A, NMr,�Ar FMAaWINEm W � e �.e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L' Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR:�f 7k -L IC -Y-- DATE PE LEGAL DESCRIPTION: I 1 Rj%S" �t'�aY�11�i 1�' Township Range, Section: QEPTH ��„I(/ SLOPE SITE PLAN 2- 3- 4 3 4 5 p 6 7 8- 9- 10 9 6 11 12 13 14 15 16 17 18 19 20 COMMENTS WAS ENCOUNTERED? WATER k ENCOUNTERED? S IF YES, AT WHAT L DEPTH? pO E Depth to Water Allen i I % Monflaring? �3 I, - Reading — Reading Date Gross Time Net Time Depth to Water Net Drop w%%•j lrJ I 4 /?CTT 54 5 Z:o7, � toy 6 1 PERCOLATION RATE �110 (minutes/inch) PERC HOLE DIAMETER b ~ TEST RUN BETWEEN ` FT AND FT PERFORMED BY: S & S ENGINEERING 1 CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loo Rand Io2� ACCORDANCE WITH ghbli'll ftT I ��JIM�GUID LINES'IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage Page Of Z - DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: !! l21A (1 -01G]� PID Number: N�pJ�,� Wastewater System: ❑New pgrade Address:r-� 4 ABSORPTION FIELD Phone: No. of Bedrooms: ❑ Deep Trench ❑ Shallow Trench ❑ Bed XMound ❑ Other LEGAL DESCRIPTION soil Rating: b• Total Depth from original grade: GPD/Sq. Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade Gravel depth beneath pipe Ft. Township: Range: Section: Fill added above original grade: 1 4 Gravel length: * ( Ft. Ft. WELL: ❑ New ❑ Upgrade Grav Itlep h: WI=,r-14 Numberof fines: Distance between lines: 1 Ft. (o Ft. Clapcation/(Private, A,B,C): Total Depth: Cased To: Total absorption area: Pipe material: �I O y Ft. Ft. I Oq (p sQ. Ft. Driller: Date Drilled: Static Water Level: Installer: Date installed: Ft. rr Yield: Pump Set at: I Casing Height Above Ground: TANK GPM Ft. Ft. SEPARATION DISTANCES 74eptic ❑ Holding ❑ S.T.E.P. To septic Absorption Lift Holding Public/Private Manufacturer:_A f Capacity in gallons: From Tank Field Station Tank Sewer Lines Well I f ( _ �_ } Matgrial Number of Compartments: Surface ef teo' (60' — — LIFT STATION Lot Ib( ID/ _ Size in gallons: Manufacturer: Line Foundation IZ, "Pump on" level at: mp off' level at: High water alarm at: Curtain Pump Mae&Model Electrical Inspections performed by: Drain Remarks: BENCH MARK Location and Description: O� Assumed Elevation: to f ENGINEER'S SEAL OF q� 4 �P�''......a,ags h •,� S & S ENGINEERING R d' �., Inspections performed by: t7094 Eael. a:..-. r _ .,_ . r� 1st •4SL . R/ . 1 .. Eagle Rlvar, Alaska 99577 S 2nde-4- 1 i • UNNO • • ) •. ® ; : f ROQER SHAFER Department of Health d uman S es approvalNo 15 r�z® Reviewed by: �`,m` R1706*. and approved Date: {oNA•�a.�� s 72-013 (1/91) MOA 25 Permit No. Page 2 of _Z_ Municipalityof Anchorage DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 • Anchorage, Alaska 99519-6650 • Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report - ��"1 1,ja-70t_1'R<e1&_ . . _egal Description: �L©l (G Li llJ( I PID No.: c:) _/-L./t v L � poi �z 'ao��Q V(L,&(- Zvr\vc M12 0 a (o n 1`5z'a n 5.T C rO® " NI CE .E��.iN30M ' L -i 1:_X_� •e.a-�p, L.."�i;, I 3 i' / IO�UTI V. NIT. co/ h/ 1 ASE 1"_qo1 72-013 A (2/91) MOA 25 ®e4% . •m1 eNNoeem Neee �eH� NmeeNN e m mm 1q •m v �n ER SHAFE �! �0 No. 215 �e•••N PAGE 1 OF 1 MUNICIPALITY OF ANCHORAGE JQ'SL DEPARTMENT OF HEALTH AND HUMAN SERVICES g 3 ga P.O. BOX 196650, 825 "L" STREET, ROOM 502 c ANCHORAGE, ALASKA 99519-6650 �'os ON-SITE WASTEWATER DISPOSAL SYSTEM (UPGRADE) PERMIT PERMIT NUMBER:SW920194 DATE ISSUED: 7/24/92 DESIGN ENGINEER:S & S ENGINEERING EXPIRATION DATE: 7/24/93 OWNER NAME:MALCHICK BARBARA L OWNER ADDRESS:10225 MAIN TREE DRIVE �a30 ANCHORAGE, ALASKA 99516 �r LjrQ PARCEL ID:02018120 LEGAL DESCRIPTION: PENNINGTON PARK BLK LOT SIZE: 45623 (SQ. FT.) NUMBER OF BEDROOMS: 3 THIS PERMIT: 3 4 LT 1 THIS PERMIT IS FOR THE CONTRUCTION OF: DISPOSAL FIELD SYSTEM 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 FOLLOWING SPECIAL PROVISIONS. SPECIAL PROVISIONS: RECEIVED BY: ISSUED BY v eel�1;1_ - � - 76 zs� . DATE: DATE: Z- 24- - 92 0 -4; HEALTH AUTHORITY APPROVALS SEWER & WATER MAIN EXTENSIONS SEWER & WATER INSPECTION ENGINEERING STUDIES AND REPORTS WELL INSPECTION & FLOW TEST SITE PLANS ROAD DESIGN SOILTEST PERCOLATION TEST STRUCTURAL& MECHANICAL INSPECTIONS ON SITE WASTE WATER DISPOSALSYSTEM DESIGN July 15, 1992 Municipatity o6 Ancho&age DEPARTMENT OF HEALTH AND HUMAN SERVICES 825 L StAeet P.O. Box 196650 Anchorage, Ataska 99519-6650 REFERENCE: Lot 1; Btock 4; Pennington Park Subdivision; ROBERT SHAFER, P.E. ROGER SHAFER, P.E. CIVIL ENGINEERS (907)694-2979 FAX 694-1211 Requeat you .issue a pe&m.it to upgrade the septic system seAving the &e6e&enced property. The existing system was observed ove&6towEng by Dan Bolles o6 you& o64ice. A series o6 teat hales were excavated (attached) .in sea&ch o6 a switabte site 6o& an upgrade. The site chosen .i6 atightZy higheA in e2evatLon than the ex.i'sti.ng system. There .is atso a good Gandy gravel .layer on which we p&opose the new teachiie2d bed with a 2 6t. sand 6.itte&. We do not anticipate any adverse eb6eet on nefghbo&.ing p&ope&tiea by the in6taUAtion o6 the p&oposed septic system. 16 you &equ,iA,e additionat .in6o4mation 6o& youA &ev.iew, please contact ua. S.ince&et y, ROGER J. SHAFER, P.E. RJS/gm 17034 EAGLE RIVER LOOP, SUITE 204, EAGLE RIVER, ALASKA 99577 !" 40' I I UPGRADE SCALE Z � pOaiZU � GiOW O NFri O rn c r- ni p G% °.a 2mrr�N 'tJ•y� C a 3F y c rq o ` O r k 4 W m r 8 i Y 0 e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ��l.G�'C.V� DATE LEGAL DESCRIPTION: I,l Q' �—l.il-�Irr" Ifs Township, Range, Section: SLOPE SITE PLAN 2 3 5 6 7 8 9 10 WAS GROUND WATER ENCOUNTERED? 11 1 s IF YES, AT WHAT / L O DEPTH? r/ 12 E 13 Depth to Water After Monitoring? Date: 14 15 16 17 18 19 20 Reading Date Gross Net Depth to Net Time Time Water Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT COMMENTS n M I. I 1 `✓�'��• PERFORMED BY: S & S ENGINEERING I CERTIFY THAT THIS TEST WAS PERFORMED IN 17634 Eagle River Loop Road No. 2nd �_ ACCORDANCE WITH AE$�F�&t IA ��O�¢UIDELINE I EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: f 4/n Lf'/���y DATE PE LEGAL DESCRIPTION: L/I Township, Range, Section: REP H7 �, SLOPE SITE PLAN biz 1 1 1 1 1 1 ' 2 3 4 5 /v 12 13- 14- 15- 16- 17 314151617 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? t S Q IF YES, AT WHAT Gd p DEPTH? I P E Depth to Water Ager oI Monitoring? f Date: Reading Date Gross Net Time Time Depth to Water Net Drop PERCOLATION RATE TEST RUN BETWEEN (minutes inch) PERC HOLE DIAMETER FT AND FT PERFORMED BY: S & S ENGINEERING I ,— 1 0 CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 204 V ACCORDANCE WITH AL&4fSAWtVWDMWgjIq#�IDELINES IN EFFECT ON THIS DATE. DATE: 72-008 (Rev. 4/85) a Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG — PERCOLATION TEST PERFORMED FOR: ` ,( �ji� 1 (��/�1�[/\�"t lCi� DATE F LEGAL DESCRIPTION: Lam) 1�`T ICir"�I tiipTZ�t`r Township, Range, Section: DEPTH T� 124L SLOPE SITE PLAN 1 ^ 2 / -iM/M L. (A 1, 3 ��—( 4 5- 6- 7 6 7 8 9 0 10 11 �) 12- 13- 14- 15- 16- 17 21314151617 18 19 20 COMMENTS L Get M /Gl�l O WATER ENC T ENCOUNTERENTERE D? o s IF YES, AT WHAT ��� L O DEPTH? __�" P E Depth to Water Agar t Monitoring? _ _ Dater Reading Date Gross Net Time Time Depth to Water Net Drop PERCOLATION RATE (minutes/inch) PERC HOLE DIAMETER TEST RUN BETWEEN FT AND FT PERFORMED BY: S & S ENGINEERING CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River Loop Road No. 204 -7' ACCORDANCE WITH tWgftT*17�%A,t' A"Iooyj.7GUIDELINES IN EFFECT 09 THIS DATE. DATE: 72-000 (Rev. 4/85) e Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES 825 "L" Street, Anchorage, Alaska 99502-0650 SOILS LOG - PERCOLATION TEST PERFORMED FOR: TJX T` rlk-L�GIy DATE PE LEGAL DESCRIPTION: t ,t iP24- YC�}--51 1�" Township, Range, Section: DEPTH �� SLOPE SITE PLAN 1 � Gross Time Net Time 2- Net Drop �1 3 3- 4 4 5 p 0 6- 1 :3o i d ✓s �.+ S 1' 4 3 7 :4c> So rA'Ir 8- 9 6 10 11 12- 13- 14- 15- 16- 17 21314151617 18 19 20 COMMENTS WAS GROUND WATER ENCOUNTERED? IF YES, AT WHAT DEPTH? S L O P E Depth to Water Ager 1 I Monitoring? Date: _(�1Z Reading Date Gross Time Net Time Depth to Water Net Drop �1 Z 1 :3o i d ✓s �.+ S 1' 4 3 :4c> So rA'Ir 5 2-02 !v3 S 1 PERCOLATION RATE 10 (minutes/inch) PERC HOLE DIAMETER fo N TEST RUN BETWEEN Z FT AND FT PERFORMED BY: S & S ENGINEERING CERTIFY THAT THIS TEST WAS PERFORMED IN 17034 Eagle River LRoad No ��((�t� ACCORDANCE WITH ghLT�f f41jaJISA�GUIDELif1E5TN EFFECT ON THIS DATE. DATE: ++ 72-008 (Rev. 4/85) ''JJ /2-UI3 (Bev. Z3178) 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 ftL—r-1E^1v—�(�jt!— PHONE °�-�-rj—�7FZ1 NEW ❑UPGRADE MAILING ADDRESS Vp, LEGAL DESCRIPTION iwe - „ D But S�z n� - t o o .� s s� l 1 NA �. f 3��1 LOCATION NO. OF BEDROOMS 3 U DISTANCE TO: Well`' / Absorptioga ea Dwelling PERMIT(�No. E8® a ZQ Manufacturer Material No. of compartmey�ts w Lie. capacity in gallons IF HOMEMADE: Inside length Width _ Liquid depth d Z Z DISTANCE TO: Well Dwelling - - - PERMIT NO. = F Manufacturer Material Liquid capacity in gallons W DISTANCE TO: Well \ t Co / Foundatiy, r L Nearest lot I E�� J PERMIT NO. O� r, r 4 1 ILL : PE No. of lines y .1 Length of e�cl� Imp Total lengtf� o Ides [O Trench width -(00 inches Distance betweep li gss N', A Top of tile to finish grade J Material beneath tile A?- Total effective ab orptig n area D inches j . w Length Width Depth PERMIT NO. f7 n F w ° Type of crib Crib diameter Crib depth Total effective absorption area w DISTANCE TO: Well Building foundation Nearest lot line Class Depth Driller Distance to lot line PERMIT NO, w w � DISTANCE 70: Buildingfoundation Sewer line Septic tank p Absorption area(s) p 1-/1ZAA �0 OTHER Qw/ �}PE MATERIALS - Y-'FDiZ. II 2.-I2cjto i uKt SOI L TEST RATIN 25 S FjQ. ' INSTALLER �7 E--x_I-1 \BILI �I�s REMARKS fes, �I.L'j C OF Al _ a• •• s� •e a w � `aeeess••ease e••ec e•ee •> ` i BOYO Jw ROWNFI6:1p j c bT- PI /( i- 7 �' • e n / / .• �Ati X00 /J J(� APPROVED �(,� DATE LEGAL /2-UI3 (Bev. Z3178) v LOCATION OF WELL (Please complete either to, Ib or le.) la.. Borough n Subdl Miskin. Lot I Block I Ic. DISTANCE AND DIRECTION FROM ROAD INTERSECTION Street Address and Area of Well Location 2. WELL LOG aterial TI 16. WATERWELL CONTRACTORS CERTIFICATION: WATER WELL RECORD . ' STAT' OF Al ASKA DEPARTMENT OP NATURAL RESOURES s Division of Geological .a Geophysical Surveys Drilling Permit No. A.D. L: No. Section No. Township N Range EO Meridian 3. OWNER OF WELL:WE Address: Wim. O Public Supply ❑ Industry ation ❑ Recharge C] commerical .. Well O Other: Idle.slit Three etl Welded 71.1, ft. 'OeDih WeightIbs./ft. ft. Depth Stickup ft. 9. FINISH OF WELL: Type:. �/of C LLf� G./ Diameter: Slot/Mesh Slee: Length: - Set between ft. and ft. Backfilling Gravel pack 10. STATIC WATER LEVEL:_ro ft. 7 17 0 Above or Of Belo land urfgco_ i Date Equipment used: r I. PUMPING LEVEL below land surface and YIELD .Left. after hrs. pumping9.R:m. ft. after hrs. Dumping. 12.GROUTING Well Grouted: E] Yee No Material: C3 Neat Cement ❑ Other: 13. PUMP:. (if available) HP C Length of. Drop Pipe ft. capacity .p. m, y 0 Subm. C] Jet 0 Centrifical C] Other- r a s 14. REMARKS:. 15. Water Temperature _oF a CI r This w 11 s Vile dale y plsdicllon and title report Is true to the IS t my knowledge and belief; pistered - sines Na L Contract Llce a Numberp r Address: ' � / ��.fj Y/`iOl/ Signed: Date: - Auf horizetl RellffsentatiSus - rm 02-WWR (Il/po Copy Distribution: WHITE -State 00", PINK -Driller, CAN ARY-Custome[.., '1 r ] P tL `rY �1� r4 F71'hilE3k IfE ;' y DEPARTMENT OF HEALTH AND ENVIRONMENTAL PRGTECTIt , $25 L STREET, ANCHORAGE; AK X64-4720. t —r E= !Si=WEFT ,, WF=I L— PEF 0: '840049, :j izD: 03/15/84 NT:" .ALMOND INC P. 0., SOX 11-2247 ANCHORAGEi AK 99511 PHONE: 345-3821' 586I P SECTION: 10 . . E.: 1.25A , SQ. FT. OR ACRES) BELQW ARE THE OPTIONS' AVAILABLE TO YOU ,IN DESIGNING'YOUR SEPTI`_' "C}_.00SE THE OPTION THAT BEST FITS YOUR SITE. . - - - - - - - - - - - - - - _. - - - E3 1E CRF?F t I F1 O PIPE .BOTTOM (FT. ) 4.0 4.0 PiEf TN &T.) 0'. 5 - 1. 0 0d, bTH <FT. > 17.0 5. 0 tuJOTH,. (FT. ). 34: 0 66. 0 E ,bL 1tti ,,CCU. YDS.) :�1. 4 18.3 ` .' «ALS? 1,000.0 ** 1, 000. 0 ** $ t G <SQ. FT. /BR) 125 125 MUST HAVE AT LEAST TWO COMPARTMENT'_ � f�.L. .. _ r - - - - - - - - - - - - - - -'-.... - THAT.` Ad!LIAR WITH'THE REQUIREMENTS FOR ON—SITE SEWERS, AND WELLS+: ' # BY THE MUNICIPALITY OF ANCHORAGE (MOA) AND THE STATE �h1ALLTHE SYSTEM IN ACCORDANCE WITH ALL MOA CODE$'AN .COMPLIANCE WITH THE DESIGN CRITERIA OF THIS P)ERMIT. v ' ADHERE T# ALL MOA AND STATE OF ALASKA'REQUII'cEMENTS FOR �3 E5 FROM ANY EXISTING WELL., WASTEWATER DISP059L SYSTEM TRr GE SYSTEM ON THIS OR ANY,ADJACENT OR NEARBY LOT 71. t RSTANp,THAT THIS PERMIT IS VALID FOR A MAXIMUM QF 31, # Cif, 'O N7 WILL REQUIRE AN ADDITIONAL PERMIT.'' }.}nrris..e r.+... Yr r,.,�Tr. , �rt r.,��, .-,.-..-.•„,-.,..,rs..-.. sn.• ....... .w . ...:..o-. ..,.i:;f�" � i d. LICENSE) ELECTRICIAN 1 11 ' 12 jlll 13 Q r 14 C -IM 15 Com" L-fzc C�ta�S 16 i :h i 17 PgE�OF�q�gs��1 Ar ti 18 i *'49 • s' 10-0009. e 19 �.. .. . 20 ,` �! '. roY C. Reid, 1. No. 2251-E mai COMM PERFORMED BY: r 72-008 (6/79) WAS GROUND WATER 1.,M S ENCOUNTERED? ,yLJ L O P IF YES, AT WHAT E DEPTH? ,, ++ __ Reading Date Gross Time Net Time SOILS LOG =� . UNICIPALITY OF ANCHORAGE • .-ra PERCOLATION as DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION TEST - \\ 10 825 L. Street, Anchorage, Alaska 99501 264.4720 /; to •e�5 SOILS LOG — PERCOLATION TEST PERFORMED FOR: :Two kp-'5 DATEPER( F�ORM,E�D: .\IA� -9/ Qnf {D0 56 1L1 + Tl 1 N RAW Sc -2-A, {� LEGAL DESCRIPTION: Y(/}'�nll�_Si )n l -SL.11��W (� �!_SLOPE 1 SITE PLAN 1'.'LYJ_I la— I 1 11 1 1 1 11 ' 12 jlll 13 Q r 14 C -IM 15 Com" L-fzc C�ta�S 16 i :h i 17 PgE�OF�q�gs��1 Ar ti 18 i *'49 • s' 10-0009. e 19 �.. .. . 20 ,` �! '. roY C. Reid, 1. No. 2251-E mai COMM PERFORMED BY: r 72-008 (6/79) WAS GROUND WATER 1.,M S ENCOUNTERED? ,yLJ L O P IF YES, AT WHAT E DEPTH? ,, ++ __ Reading Date Gross Time Net Time Depth to Water Net Drop ia'So .-ra /100 as 10 /; to •e�5 fHao l:ao -9/ PERCOLATION RATE (minutes/inch) TEST RUN BETWEEN '91-5 FT AND -:5- FT _CERTIFIEDBY: DATE: du1. w ALASKA *1R,0nMCnTAL COnTROL SCIJCCS, IN, Engmeerino 6 Enuironmental Studies SupplementalSoilsInformation. TC%I Subdivision / /i rGa),A/,Block LOT LOT % LOT % LOT TH TH TH G TH H o �� F T 2 2 �- r r�} 2 3 3 G�� 39P, 4 4 4.F 3 � 4 r A 5 5 0 6 6 6 q 'it, 6 7 7 7 c 8 8 r 8r 8 y 9 9 9 10 10 10 10- 11 11 11 11 12 12 12 12- 13 13 13 13 14 14 14 14- 15 15 15 15- 16 16 16 16- 17- 17 17 17- 18- 18 18 18 19 19 19 19- 20- 20 20 i 20 IM West 33rd Auenue. Sutte B • Anchoroge. Alaska 99503 0 (907) 2761361 Municipality of Anchorage Development Services Department Building Safety Division . On -Site Water & Wastewater Program 3 1 4700 South Bragaw St. C' P.O. Box 196650 Anchorage, AK 99519-6650 `, ` www.ci.anchorage.ak.us (907)343-7904 10- CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING mss. Parcel I.D. 020-181-20 HAA# o ®,9S ��®®� 1. GENERAL INFORMATION Expiration Date: q 3 n LL Complete legal description PENNINGTON PARK SUBDIVISION: LOT 1, BLOCK 4, Location (site address or directions) 17330 BETTI JEAN * ANCHORAGE AK. 99516 Current Property owner(s) Mailing address Lending agency Mailing address Real Estate Agent Mailing address TOM & CHRIS FARRINGTON Day phone 17330 BETTI JEAN * ANCHORAGE, AK. 99516 Day phone JENNIFER ZIMMERMAN w/COLDWELL BANKER Day phone 2525 "C" STREET ANCHORAGE, AK. 99503 Unless otherwise requested, HAA will be held by DSD for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: 345-2618 265-9170 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 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 samples. (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, t 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 GARNESS ENGINEERING GROUP, Ltd. Address 3701 E. TUDOR ROAD, SUITE 101 * ANCHORAGE, AK 99507 Engineer's Printed Name JEFFREY A. GARNESS, P.E. Engineer's Comments: In conducting this evaluation, GEG, Ltd. attempted to provide a thorough, conscientious engineering analysis of the system in accordance with ADEC and MOA DSD Guidelines & Regulations. The reported results described 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 soils condition, groundwater 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 the system. Satisfactory test results do not guarantee future performance of the system, nor do they guarantee that there are no hidden defects or encroachments. GEG, Ltd. can therefore not provide any warranty or future estimate of how long the system will continue to meet the operational requirements of the ADEC or 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 Approved for 3 bedrooms. Disapproved. Conditional approval for Attachments: HAA Checklist Septic System Advisory Well Flow Advisory Phone 337-6179 Date 42� 1 1/6 4 - bedrooms, with the fllowing stipulations: Manitenanoe Agreements Supplemental Engineer's Reort Other QP,..,..... �,10 ON-SITE WER AND WASTEWATER PROGRAM.' By: e/ (/t/, 6 d C Original Certificate Date: (^ 3 (Rev. 12101) 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: PENNINGTON PARK SUBDIVISION; LOT 1, BLOCK 4 Parcel ID: 020-181-20 A. WELL DATA Well type PRIVATE If A, B, or C provide PWSID# N/A Well Log (YIN) YES Date completed 5/7/1984 Sanitary seal (Y/N) YES Wires properly protected (YIN) YES Total depth 50 ft. Cased to 44 ft. Casing height (above ground) 12+ in. FROM WELL LOG Date of test 5/7/1984 Static water level 0 ft. Well production 6 g.p.m. WATER SAMPLE RESULTS: Coliform 0 colonies/100 ml. Arsenic: N/A mg./L. B. SEPTIC/HOLDING TANK DATA Tank Type/Material AT INSPECTION 4/29/2004 0 ft. 3.55 g.p.m. Nitrate 1.33 mg./L. Other bacteria 0 colonies/100 ml. Date of sample: 4/29/2004 Collected by: GEG, Ltd. STEEL Date installed 8/3-5/1992 Tank size 1000 gal. Number of Compartments E Cleanouts (Y(N) YES Foundation cleanout (Y/N) YES Depression over tank (Y/N) NO High water alarm (Y/N) N/A Date of pumping 6/7/2004 Pumper MCDONALDS PUMPING C. ABSORPTION FIELD DATA *BELOW FINAL GRADE Date installed 6/28-29/2004 Soil rating .p.d.( r ft2/bdrm) 0_5 System type BED Length 51 ft. Width 18-25 ft. Gravel below pipe 0.5 ft. Total depth 4.7 ft. Eff. absorption areal 000+ft2 Monitoring tube YES Depression over field NO Date of adequacy test NEW SYSTEM Results (Pass/Fail) For bOroem ------------ Fluid depth in absorption field before test —in.. Watered New depth _in. Elapsed Time: _ min. epth _ in. Absorption rate >= g.p.d. enation treatment (past 12 mo.) (Y(N &type) If yes, give date - 1 D. LIFT STATION Date installed "Pump on" level at in. E. SEPARATION DISTANCES Size in gallons High water alarm level at in. Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 100'+ Public sewer main N/A On adjacent lots 100'+ On adjacent lots 100'+ Public sewer manhole/cleanout N/A Sewer /septic service line 25'+ Holding tank N/A SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main N/A Water service line 10'+ Surface water 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line 10'+ Building foundation 10'+ Water main N/A Water service line 10'+ Surface water 100'+ Driveway, parking/vehicle storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots 100'+ F. COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that t 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 Print Na mp JEFFREY A. GARNESS Date Sy/ 4- HAA Fee $ u3b n { 1-+J . DD 2t cSh Date of Payment 0301ay Receipt Number (Rev. 12101) M Waiver Fee $ Date of Payment Receipt Number co ti M w C3 O O O V) 60;1 h / UWELL \ � UqP daF Ago 0 oa d 4C) T SHANE A. HOLT. LS -6914 ..�j R Ca 04a h'' a d o S t,, 4N Oo -� � `�` ofessiorpl o S / AS -BUILT SURVEY S I SCALE : i ' = 4¢' LENDING INSTITUTIONS SPECIFICALLY TO SHOW OR EASEMENTS AND IS NOT TO BE USED FOR --NTS OF RECORD, OTHER THAN THOSE SHOWN ON THE RECORDED PLAT', ARE NOT SHOWN HEREON. ANY FENCEL€NES SHOWN ARE LOCATED APPROXIMATELY AND ARE NOT TO BE USED TO DETERMINE ,ATE STRUCTURES. SVING SHOWN MAY BE APPROXIMATE DUE TO SNOW CONDITIONS. I HEREBY CERTIFY THAT I HAVE PERFORMED A MORTGAGEE'S INSPECTION OF THE FOLLOWING DESCRIBED PROPERTY. LOT 1, BLOCK 4, PENNINGILIN PARK SUR, ENCROACHMENTS EXIST OTHER THAN NOTED 5YA'I $A ANCHURAGE'., ALASKA PHIS 24TH DAY OF __ AINE2004_-_-. HOLT LAND SURVEYING 9377, FE113-21 TEL. 345-5513 MUNICIPALITY OF ANCHORAGE fi !/ DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel LD. # - 1Q1 - - 1. GENERAL INFORMATION Complete legal description HAA# 1-i1`1QI-;Li�(L Lot 1; Bock 4; Pennington PaAk subdivision Location (site address or directions) 17330 Betti.jean StAeet Property owner Ban.bwca MaE?ch,ick Day phone wk.: 274-4684 346-3805 Mailing address 10 95 Main TlLeo. Dnfve Ancho)tage, Akwska 99516 Lending agency Day phone Mailing address Agent Day phone _ Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: Individual well XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: Individual on-site XX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/91) Front MOA 421 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm % g g TNr5N==RlNr, Phone Address 17634 Eagle River Loop Road No. 204 Engineer's signature 6. DHHS 'SIGNATURE Approved for Disapproved. Conditional approval for _ Additional Comments M bedrooms. Date bedrooms, with the following stipulations: The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DH HS 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. 7M25 (Rev_ 1/91) Back MOA R21 Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST 44 Legal Description: LaT 4 RLK 4-! jJIU1\)i1u r70n/ 14 Parcel I.D. I A. WELL DATA Well typeIUA-_?F2If A, B, or C, attach ADEC letter. ADEC water system number Log present &N) YES Date completed S-7-841 Driller &8VUE allim 1. Total depth Cased to 7& Casing height ` 't &/N)Sanitary seal /N) t/ leS Wires properly protected 6/N) W�S FROM WELL LOG AT INSPECTION rn Date of test �3_CJ f2_ c 9 Static water level r / rr1 C" 0G) ^' D Well flow6 m ^�� 6 g.p.m. O g.pC rn < 9 Pum level P rTt " I or � SEPARATION DISTANCES FROM WELL TO: Septic/!j tank on lot ias ; On adjacent lots X00 Absorption field on lot r SS I ; On adjacent lots loo Public sewer main 0/4_ Public sewer manhole/cleanout /LI�i Sewer service line r @/(r� (� (5 Petroleum tank fif_ ut ) ncwN WATER SAMPLE RESULTS: Coliform Nitrate �72 rK Other bacteria Date of sample: (9 —c Z Collected by:�« S �NCsIn1F_a(U B. SEPTIC/NTANK DATA Date installed (9 �_ �(2 Tank size Compartments Cleanouts 61) 2, foundation cleanout (#N) Va Depression (Y/@I High water alarm (Y/ J(�' NZ)j4 Alarm tested mo N�i4 Date of pumping" ® GW T/ fllc Pumper %(/II 2 SEPARATION DISTANCES FROM SEPTIC/G TANK TO: r Wells) on lot 1 a5 On adjacent lots / ib Foundation r )� r r r To property line q_0 4' Absorption f ield 4S'* Water main/service line io l Surface water/drainage joo I "I' 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT a ' stSTATIONA' Dalled Oq Manufacturer Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical codes on" level at Man SEPARATION DISTKNCE FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA "Pump off" level at Cycles tested Date installed �' �— �%2 r Soil rating System type Length S I WidtR a S (AUE. Gravel thickness 6 rr Total depth 6 r Total absorption area S SF Cleanouts present (Oq) Y15S Depression over field (Y,) Aurvcro Cys Date of adequacy test AJ14 1V,5W Results (pass/fail) NIR for _? bedrooms Peroxide treatment (past 12 months) (Y/O , If yes, give date h/l/, SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot IIs' On adjacent lots /60,/ Property line r , To building foundation S To existing or abandoned system on lot m r On adjacent lots d,S 4- Cutbank /Od r� Water main/service line :�8 Surface water 106,4 - Curtain drain IV(WF_ KNowr- E. ENGINEER'S CERTIFICATION Driveway, parking/vehicle storage area I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect S & 5 ENGINEERING Signature 17034 Eagle River Loop Road No. 204 Eagle River, Alaska 99577 Engineer's Name Date 8— `12 HAA Fee $ 170,62-0 0-1;? Waiver Fee: $ Date of Payment _ 1 — I2. Date of Payment Receipt Number °1-35413 ( 3Z/76 Receipt Number 72-026 (Rev. 3/91) Back MOA 21 ?R J. No.f date of this inspection. MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date (a) Legaescription (include lot, blo t&, spbdivis on section, township, range) (b) Applicants Applicants Addres or dire" ns) j; (c) Applicant is (check one) Lending Institution ; Owner/builder ; Buyer F::1 ; Other [::I (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent Address Telephone (f) Mail the HAA to the following address: 2. Type of Residence Single -Family Multi -Family Number of Bedrooms Other (describe) 3. Water Supply Individual Well Community � Yublic L— 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 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 21 • 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 regula- tions in effect on the date of this inspection. / �7 Name of Firm } j ( f) r� f �, lw/l �ri �_:f'f(i.Telephene ,'7�i Address Date (ENGINEER SEAL) A Poo4 6. DHEP Approval Approved for bedrooms By j/�� ' 3v z.Date Approved X Disapproved Conditionz Terms of Conditional Approval CAUTION sir®yeenoo os u y '; oe° ti , cee yw§eeocoo a.aoo-.' a o� '> 4.Oue.'o. THE MUNICIPALITY OF ANCHORAGE DEPARTPENT OF HEALTH AND ENVIRONMENTAL PROTECTION (DHEP) ISSUES HEALTH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON THE REPRESENT- ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPENDENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OF ALASKA. THE DHEP DOSS THIS AS A COURTESY TO PURCHASERS OF HOMES AND THEIR LENDING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEbERAL AND STATE REQUIRE- MENTS. EMPLOYEES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICATE IS ISSUED. THE MUNICIPALITY OF ANCHORAGE IS NOT RESPONSI3LE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. RR4/ej/D18 EPage 2 of 21 M (DHEP SEAL) 7-19-84 MUNICIPALITY OF ANCHORAGE (MQ"ICIPALITY OF ANCHORAGE HEALTH AUTHORITY APPROVAL (HAM,DEPT. OF HEALTH & RONMENTAL PROTECTION CHECKLIST - FEBRUARY 1984 `.AUG 2�19�/ A. WELL DATA _%�/��Y L D t Well Classification_ If A, B, or C, D.E.C. A proved(Y/N) Well Log Present /(Y ) Date np � Ccleted Yie d Total Depth (lam , Cased to y� D�pth� Grouting Static Water Level Pu Set At Casing Height Above Ground' Sanitary Seal on Casing v .l Electrical Wiring in Conduit ( ) Depression Around Wellhead (Y ) Separation Distances from Well: To Septic/Holding Tank on Lot % / On Adjoining Lots %()n To Nearest Edge of Absorption Field,on Loth; On Adjoining Lots /G>Q �7(�) To Nearest Public Seer 'ne � To Nearest Public Sewer Cleancut/Manhole To Nearest Sewer Servic Lir. on Lot,14// Water Sample Collecte By r ! Date �/ Water Same Test Results L 1 1 , - Ccumnts 1' /%%-rL5a,( d cilm B. SEPTIC/HOLDING TANK DATA Date Installed //7 A �u�Size M/P, 1k No, of Coripartments Standpipes ( ) Air -tight Caps /N) _ Foundation Cleanout Y ) Depression over Tank ,(Y& Date Last Pumped -P' / Zzi60C P L1I[Ipng/Ma � i intenanContract on File (Y )w for 1-1 Holding Tank High -Water Alarm (Y/N) /7 TemHolding Tank Permit (Y/N) Temporary Hol Separation Distances from Spptic/Holding Tank: To Water -Supply Well �� Z� To Building Foundation To Property Line * _ To Disposal Field In To Water Main/Servicene To Stream, Pond, Lake, or Major Drainage �-L(1� [Page 1 of 21 �/ 2-I5-84 6 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Da s'gn ���(� /�%f/� , Date Installed f h 1&6JLC// — Length of Field Width of Field Depth of Field Gravel Bed Thickness r Square Feet of Absorption Area Standpipes Present /N.) Depression over Field (Y ,Date f st Adequacy Test C Results of Last Adequacy lbst l'1 L Separation Distance from Abscrrptjep Field:" To Water -Supply Wall Citi I. To Property Line �e To Building Foundation p To Existing or Ab4ndoned System on Lot ����- ; On Adjoining Lots To Water Main/Service Line To Cutbank(if present) �w _L J� To Stream/Pond/Lake/or Major alnage Course r To Drivewa Area, or Vehiccl'e Storage Area iPaarlking Comments D. LIFT STATION Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level Tested for Electrical Codes(Y/N) Comments e/Access (YIN) Off" Level at Vent (Y/N) Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. 1 Signed Date Company MOA No. KB1 /d5/s [Page 2 of 2] DF N G e•Ya`" � ��f� �t "s No. 2253E .'