HomeMy WebLinkAboutPETERS GATE BLK 2 LT 7 (Kev ublu2ti u) Municipality of Anchorage On -Site Water and Wastewater Section • (907) 343-7904 Page 1 of 3 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP211057 PID Number: 051-541-17 Dwelling: 0 Single Family (SF) ❑ with ADU ❑ Duplex (D) ❑ Two Single Family Project: ❑ New FO -1 Upgrade Name Al and Adele George ABSORPTION FIELD ❑ Deep Trench A Wide Trench ❑Bed El Mound Site Address 25112 Sierra Mesa Cir Chugiak ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 3 4 GPD/SF 1.5 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 1 Ft. Gravel depth beneath pipe 0.5 Ft. Subdivision Block Lot PETERS GATE 2 7 Fill added above original grade 2.0 -2.1 Ft. Gravel length 26 Ft. Township Range Section Gravel width 5 Ft. Beds: Number of Lines Distance between lines Ft. SEPARATION DISTANCES To Septic Absorption AWWTS olding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Tank Line 130 Ft2 1 Ft. Well >100' >100' >100' NA >25' TANK X Septic ❑ S.T.E.P. ❑ Holding Other Manufacturer Anchorage Tank Capacity 1500 Gal. Surface Water >100, >100, >100, NA Material Number of compartments Lot Line >10' >10' >10' NA NA plastic 2 Foundation >1 0, >1 0, >10,J NA AWWTS module Capacity Remarks Anchorage Tank NA Gal. Alarm location in furnace room Electrical installed by 907 electric PIPE MATERIAL House to tank 3034 drainfield Tank to 3034 Installer Richard Person Construction Drainfield 3034 CO/MT3034 Inspector Curtis Townsend BENCH MARK (Assumed elevation) 100 ft Inspection 15' 6/7/21 6/8/21 dates: Location and description 2nd Yd 10/30/2d 41' bottom of siding at shed ON-SITE WATER AND WASTEWATER SECTION APPROVAL Engineer's Stamp Conditional Approval: Date f4•...... . Septic Systema, Approved Date _._ Note: this approval oes not include well permit requirements. (Kev ublu2ti u) VACANT LAND, NO WELL OR SEPTIC LOT 1 THERE ARE NO STEEP SLOPES WITHIN 50' OF THE PROPOSED TANK. VACANT LAND, NO WELL OR SEPTIC L W y \off w W JPS Lzo_+j W '13 f � H y Go -o w L / w Z n� I LLI � r N m z W � 202' Z � J 0_0 mv n / z V) 0-1 i =1, I SCOPE OF WORK 1 1. REMOVED EXISTING SEPTIC TANK. 2. PLACED NEW 1,500 GALLON TWO-COMPARTMENT TANK WITH ORENCO AX20 ADVANTEX FILTER POD AND TIED INTO EXISTING ABSORPTION SYSTEM AND NEW ONE. NEW TANK IS OUTSIDE THE 100' WELL RADIUS AND 5' AWAY FROM EXISTING FIELD. 3. SOIL MOUNDED OVER TRENCH TO PROVIDE MINIMUM OF 3' OF COVER. 4. ALL CONSTRUCTION IN ACCORDANCE WITH ALL REQUIREMENTS SPECIFIED IN ANCHORAGE MUNICIPAL CODE CHAPTERS 15.55 AND 15.65. LOT 2 LOT 3 NEIGHBORING SEPTIC IS > 10' FROM PROPERTY LINE I Record Drawing Prepared for DESIGN PARAMETERS BEDROOM: 3 (450 GPD) SOIL PERCOLATION RATE: 18 mpi PROPOSED CATEGORY III APPLICATION RATE: 4 gpd/sf AREA REQUIRED: 112.5 SF SYSTEM TYPE: SHALLOW TRENCH 26'x 5' x 6" EFFECTIVE DEPTH YIELDS 130 sf 8 MAXIMUM DEPTH OF EXCAVATION TO BE 18". OSHED 100' 3 BR HOME SLOPE 1 CO3 SLOPE 14% I NEIGHBORING WELL IS LOT 6 > 100' FROM PROPERTY LINE AL AND ADELE GEORGE 25112 Sierra Mesa Cir Chugiak, Alaska 99567 PETERS GATE BLOCK 2 LOT 7 EKLUTNA ENGINEERING, LLC 19162 MOUNTAIN ROAD CHUGIAK, ALASKA 99567 (907) 406-1058 OSP211057 DATE: 2/08/2024 DRAWN: CLT SCALE: 1" = 40' PID: 051-541-17 SHEET 2 OF 3 FCO ,)TANK MT DV 'ORIGINAL BED (I :z \l EXISTING 35' x 18'Q x 24" EFFECTIV DEPTH BED M T, TYP (n NEW 23' x 5' x 6" EFFECTIVE DEPTH SHALLOW TRENCH, INLET LINE ENTERS AT MIDPOINT. NEW FIELD MINIMUM 6' AWAY FROM OLD BED. UrAV q •�: •� '•49TH0 .....::..1 .................................. ♦ �: CURTIS TOWN SEN D. �jG�^: Y/C 11904 1500 gal TANK W AX20 FILTER Lzzlu .0 i L� 1 D�.4 FG 99.8 mo o� 99.7 OG 97.7 7 7 GROUNDWATER IN OCT 2020 WAS FOUND AT 93.8' MARK A B TANK MH 44'-0" 62'-10" DV 51'-11" 69'-5" CO3 51'-0" 73'-2" MT1 104'-1 " 130'-2" C01 105'-1" 131'-1" MT2 125'-0" 149'-4" CO2 125'— 7" 149'-10" Record Drawing Prepared for `%1L1L1k AL AND ADELE GEORGE �.�p.E 0� � 4*��� 25112 Sierra Mesa Cir Chugiak, Alaska 99567 AF?° #, PETERS GATE BLOCK 2 LOT 7 ; 4 TH * �� .....::....... ....................::..... OSP211057 %. .. 0 EKLUTNA ENGINEERING, LLC , ND-. DATE: 2/08/2024 �j� t:CURTIS TOWNSEND: � DRAWN: CLT ��'' No. CE 11 04 19162 MOUNTAIN ROAD — �Z /g�Z,i CHUGIAK, ALASKA 99567 SCALE: 1 — 10' �� ajjL '1' • (907) 406-1058 •4��-;;i•• PID: 051-541-17 SHEET 3 OF 3 Q m o � z m O N 00 W N U0 L4 V O O ID z � A -• p p 0- w O N S o ro O _ -• O' ro w p d -•'p moo"=.ox`con-.m � v p op .� - w r.o v-oo I - o _ a o o :Z___ vc o a da � n�v N o w ro c o o ro� a rt o-- -•-� o �o� Dm N o ro fD m ro o a _. • ro ? w O - d p c N'-•,pccv-o p do- .0_ oE _ o _ , -. -ro va q f«m o ro m m •poo � 0 Dyrov� Ow N�SS� - ro O ro� ro p 0- p _. q �- •-y oa o '�o c o -• ro .-. o c n -«o fwm mmm�gm oro��� m�ro =r = o X X 'x X o p CSD v = x X _ ca O N s c'? CD CD 0- = X x x sl CD— rt CQCD -= o m co O: O ° m < m ai t— to o CL -0 O a ;Ea Ji ® CD O CD a m O CD CL = m zm c'D ai 0 7, - Z —1 vJ 3 = m Co - crn7 ® M , CD -`zo s p �j r G) O y 0 a $ �, P < r m D D - ; n P_ o D w S _ X z O V A rn =r = o =- — ui v = v c o p CSD v = O c a @ co rt _ ca O N s c'? CD CD 0- = aW. 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O io a; OD --------NO* -41' 38"W 229.40' -------- (NO-09'00"W 230.00') µ t�y O ,ry � C o 0 x v m � i m Z I t1 m z Z co co to m tp m r m Cil r 1 U) O (A oz G) W Ln -I > �— r n o rn ®® U N m gni 41 a 0- (n cn cn o �' j N 0 O P w �F?•y.�,� (A Sit to .. v 'o 0 (NO'09'00"W 229.48') SO' 48' 15"E 229.12' p� --- 2Z 4 W p� ®�•— O' ® -®® s® r s s® r _ SIERRA MESA CIRCLE o 9DGE Of /"AV9 997" q (NO -09'00"W 229.42') MUNICIPALITY OF ANCHORAGE On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite On -Site Wastewater Disposal System Permit Permit Number: OSP211057 Work Type: Septic Upgrade Tax Code Number: 05154117000 Site Legal Address: PETERS GATE BLK 2 LT 7 G:1262 Site Mailing Address: 25112 SIERRA MESA CIR, Chugiak Owner: GEORGE ALLEN F JR & ADELE L Design Engineer: EKLUTNA ENGINEERING, LLC* This permit is for the construction of: Effective Date Expiration Date Lot Size in Sq Ft �1»cnt o� "AA 1I `� L)ehartin n Total Bedrooms: 3/22/2021 3/22/2022 54014 Q Disposal Field Q Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall 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 shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: Date: Issued By: G C/ Date: 2 3 6UIC,IALITY OF ANCHORAGE Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 051-541-17-000 Property owner(s) GEORGE ALLEN & ADELE Day phone Mailing address 25112 Sierra Mesa Cir Chugiak AK 99567 Site address 25112 Sierra Mesa Cir Chugiak Legal description (Sub'd., Block & Lot) PETERS GATE BLK Legal description (Township, Range & Section) Lot Size 54,014 Sq. Ft. Number of Bedrooms 3 2 LT 7 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (® all that apply) Absorption Fieldf Initial ❑ Single Family_,(SF) El (w/wo ADU) Septic Tank El Upgrade ❑ ~-- "J Duplex (D) El Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the ab ve information is correct. I further certify that this is in accordance with applicable Muni,-ipbal Codes. , (Signature of propeYty owner or authoriz6d ag Permit/Rush Fees: $595 Waiver Fees: Date of Payment: 3 y 020 Q f Date of Payment: Receipt Number: OO 2 `i 1 Receipt Number: Permit No. OSP211057 Waiver No. GADevelopment Services\Building SafetylOn Site Water and WastewaterTormsUient FormsTermit Application.doc Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211057, Deb Wockenfuss, 03/22/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211057, Deb Wockenfuss, 03/22/21 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP211057, Deb Wockenfuss, 03/22/21 N -F L�TCIPALM` OF ANCHORAGE ADVANCED WASTEM-AT 1E.R. T REATMENT SYSTEM, MMINTEN.4 NICE, AND AG, REEIvE1NTT-beT =- "AG- REDNE-N—u-P Nuade zm3 entemd into as Gf thir. -'m Day of 61, rof 20 2. 1 , b,,'2M. baweem PJ4k. NNER ar--d ina=3 vvubrat, -e b1z m 3 c 3 iii: d -- Anchu (AINIC) 15,65,365, In con (dersni cri. af-"6c muluid-ummmants IhC pidll1--N-- Wl U:iS The IN-lb-nicip4ily gra tspemissiclu Tw-fis-z Ownwriv -pulli7c and. awralk, =, Advanced. Waslewalel. Trea it, I& item JAN -%71;), dc,scribcdmi /' u1 lomted e7l I Itaifiteoftom'Repain fund Aber (Owner J'S re-qw'rcxi to .id., =6 mtand and inillml mxbw- Throughom the lerm of this � kgreemon-1, the OvmeT sliarl) mici into a, wrvimarrotrbcm MILI an, AWA78 sendqe and Maimcmqno�t pro-vidcT a%-,-)mYvcd- by ibc-IMU03-c-lilp-0ilY aw the� canditi n. carmblof poTfb,-7nin�T,.:R,.-; de -S3 an- -p XIM wcm gntdl d nA=Ih- ti it fti pa rdanmen wLffi -fes. PMM3 3 -Rp?rQlVVI!' &[ Gp -eM-001 i , the JAM It shulE 'br- the reumm-bili.tv of the, Ck-vter durm',-_.-, the tefm cpf ito.AgrQcr---Yid -,- tai pa -v foj- P -J -T rLe t c i'lnij 5- - lAe-s aulannual Main-te c -a i I v S*4 QQ tra � 0 0) L'mncr agrocs thoor-hr and QT tw, mazdam-rcif s w-ppzxnratrec -m H in.9p. 33CT—MSM-� MK- ELIb.amcm. Fcpairs- -or p0mall ffim--,d Rlt="c..y'n-'q ta'a.c: Systc:z. 100 01 YAT-ir-r- ackvmrwrjexc:gcs that regulai muia.`l�rwnu,-- of u --q._ Vkr%rTS- teduc,� mbe pa -le -i -al Fmilurt of tht sysL-,.m, wbir.b. u-ou L-1 i r la i3e. sewaee bacRv 3 widmmu'lN, re -a-Im.4 .0, r ciM-jMflv7Jd p Te p1l:10—e fftem 1. Of3 Page I Ti gess that the lvlk3r&!pafky Ml Tr -M. 3c5l.rCcr-%TCS 433:111. kinkmunce an -d .repm front to m—PDwift4aunr's r i tie tOT n=131121111nCe, Pfb%lidev- C) um e r a c. kn rrivk- d g e s I h.% - tk: fits f -P.- r f. � it i, I ig lx ma: n 12 6 ri an a rcpai:r ; a a A), WWTS : vnay'be assess.&I in, acccTdanci; wilb A -M -C 14.6i.11.0AI, ► Owueragrees ic, grant the h1midpably rinasomablQ .ac ss 'to-tutim'd inspect dw AWWTS.- TheN.WiNci, IV paliN� wiTI. Dmier. agreers -tit wNithof a y sal.`c OT b=-,B�r:Df tl'd.rGf fl3e JIMUP--*�.f WE --Wt 00=f 1 W D,,C%V CWtificue: af On-SitD S.,v,,Mcnis ApprrivpJ. I- - Dvxmer agrees tbo dhc.-,.A.WVj-N and mmllAcnance Ttgurnt �-K, a -S. txcpvLd� bie f1w. A*WW, TS -vcDdcr,-'Lpst-q.11cr anci apron n�l by d -m- Nlanil'pal'4, av- -lh:' P. im [d e I i n as f b -r Tic oo w, 1 cr c%n, --jcna g:nd.. L -f the 1T= `A AWNYT-s- wwxi MOMr o r tai -t. wnuv3.-1,M-:g -af'lh--AWWTS as rNuif r kp,:rccs to malTi In - - rc-mot AWA7-q apprc-fvql, The te-P-Tj nf thj,., Agr,merit slwll bct6n on lite val. by the MunicipaRty to c�pvratc ft- instalfod, 5,vSX'M,,,OC UpOn: t=.ftr of tide, and. coli ;cim, linue wlifle The AWWTS fsnp;-TTxJcinp.2 or- wn-jil Odd! is trangfegnbd. ttj, NDTk%%%YNWj. 711C jf�jttvc - c TOM. 1.6pall al an)"fln to eilfbnce a of fh - lv� I -q ft 3- A fj r c, --m ma f: shah Jin ro, n M, N or in W, v., wk, - affcv wwv cons6ftn- a - U ahe vah-A Agnent c(ramyI partro, or tea pTy r-.vcTv prcnm Ion h-=af- v LkIlL nr.& uft=-ril Aall only be mne-aded by c-ruhonized mpwsmmiv es of the Owner asidINfumicipaRMy. Any:aftempt-to amend lhusccmcn! c� hc.an unauffic)rjud reshabc present4WIve U -r klm-M-11IO&W. ro-cals - ll -- void- ch:Llife -rlf I -lw- Amy;AvJil O.W-Un aTi'sing-I'MM thais A me -La sh&H be. W -ought in -Lhe Superior Co-unfortk.- Thirdludicial DistTi-AvEtbt Swe of Ma l= :L- Arr 'Le 'hor., `hc of -43%-c- an ig of tnf !wq lhtStat.ervFAh.%kashal]., tie. Ls � d obli atkvn-s h rig cs under fh3is.A;-=Tc,-meat. 7. SeverabiLif.3.7 Atty -provision.-', Ofthis.Agneta-efft dwreed, inmalid by avcun,e� 00-M-petm LmsdEction shat] :t inv-.-Aidale the D ii nm',PTO-Osion-s of 'the Agrczm- cat (�cvi,95A.&2018) Pue 2 0, f 3 OWNER: By:hu A, J� (signature) Date: Q� 0 f k -E (print name) STATE OF ALASKA ) ) 5S. TH RD :iUDICIAL DISTRICT ) The foregoing instrument was acknowledged before me this a day of f LISTATE flP ALASKA ,y �01 LI2Y PUBC I OR A%, .SKS; IOTf�E�YpEl?L!C My Commission expires: 1 ODd4 Felicia R. Burst F�+f CCRnipMSfOT: ExpiresV :_W� INIC IPALI rY: By: (signature) Date:2 21 (print name) Title: (rev. 05/18/2018) Page 3 of 3 AS -BUILT rik v m I hereby certify that I have surveyed the following described property: _ % C k 2— — Sir �1 aqr! !/ , T1 P, Anchorage Recording Precinct, Alaska, and that the improve- ments situated thereon are within the property lines and do not overlap or encroach on the property lying adjacent there- to, that no improvements on property lying adjacent thereto encroach on the premises in question and that there are no roadways, transmission lines or other visible easements on said property except as indicated hereon. Dated at Eagle River, Alaska this 30 day of -5--' 4 1982 R013FAT C. JOHNSON 4 SCALE: Registered Land Surveyor No. 880 -LS 1" = q -O Box 456, Eagle River, Alaska Phone (907) 694-2543  MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTEC f"lON ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORTJ~NE NAME ~ IPHONE LEGAL DESCRIPTION ~LOCATION NO. OF BEDROOMS ~ IWell [ Absorption area Dwelling PERMIT NO. O ' Material No. of compartments ~ ~ Manufacturer ~~ Width ~ T~ ~ ~ ~ Liq. capacity in gBllons Inside length Liquid depth ~0~ 0 IF HOMEMADE: Well Dwelling PERMIT NO. ~ ~ DISTANCE TO: O ~ ~ Manufacturer Material Liquid capacity in gallons ~ DISTANCE TO: Well //~ * Foundation ~O .~ Uearestlotline~o~ PERMITNO.~~,T~ ~ Trench width Distance between lines ~ N°'°flines ~ Length°feachline~ O Total lengthoflin~o ~O I~ ~nches ~ Top of tile to finish grade ~ , Material beneath tile ~ inches Total effective ~o~ti~area. Length Width Depth PERMIT NO. ~ Type of crib Crib diameter Crib depth Total effective absorption area ~ Well Building foundation Nearest lot line m DISTANCE TO: ~ Class Depth Driller Distance to lot line PERMIT NO. ~ Building foundation Sewer tine Septic tank Absorption area(s) ~ DISTANCE TO: OTHER PIPE MATERIALS SOIL TEST RATING INSTALLER ~EMA~S ' / Ho APPROVED DATE LEGAL 72-013 (Rev. 3/78) Permit Departmen )f Health and Environment ~ec~io 825 L Street, Anchorage, AK. 9 264-4720 ~ ~ * * * HANDWRITTEN PERMIT * * * ~- 'f~' WELL AND/OR ON-SITE SEWER PERMIT Applicant: v~.~.,¢~ Location: Legal Description: Type of Soil Absorption System Is: Trench: Drainfield: Maximum Number of Bedrooms: ~ Mailing Address: Phone Number: ~~ ~/~ ~.~/~), LOt Size: ~ ~ Holding Tank' Seepage Bed: · Soil Rating (sq.ft/br) The Required ~ize o~ t~he~.S~i~_~rp, tion,System Is: LENGTH . GRAVEL DEPTH ~ ' WIDTH DEPTH 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(HOLDING) TANK SIZE = /~OO GALLONS * * Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. * * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this departme will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 fe for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a Private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, i 9 8 3 * * * Z certify that: (l) I am familiar with the requirements for on-site sewers and wells as set forth by the Mun~pality of Anchorage. !2) I will/~tall the~stem in accordance with codes. 3) I un~rs~d that/z~e on-site sewer system may require enlargement if .//~ ~//////////////th~res~v~/~~led to include more the2 3~droz.~.~ S igne~: ~/~.//~.~ ~/ Issued '~i~a~t Date: SWP/024 (1/81) 1 2 3 4 5 6 7 8 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST /~ SOILS LOG [] PERCOLATION TEST SLOPE 10 11 12 13 14 15 16 17 18 19 2O COMMENTS Robert A. ;had,er No. 1457. E PERFORMED BY: ENCOUNTERED? O P IF YES, AT WHAT / DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop RATE CERTIFIED BY: DATE: 72-008 (6/79) MUNICIPALITY OF ANCHORAGE 4 O DEPARTMENT OF HEALTH AN ENVIRONI~I~NTAL PROTECTIO.I~.. ~25 L. Stme~ A~-h~a~e. Al~ka ~5~1' SOILS LOG - PERCOLATION TEST ! [] PERCOLATION TES~..:.. 10 WAS GROUND 'WATER '1 1 ENCOUNTERED? 12 IF YES, AT WHAT DEPTH? 13 15 16 17 18 PERCOLATION RATE Gro~ Time Net Time Depth to Water _ (minutes/inch) Net Orol~ 72-008 (6179) by DOC Co. dba SULLIVAN WATER WELLS P.O. BOX 272, CHUGIAK, ALASKA 99567 · TELEPHONE688-2759 OWNER OF LAND '-.L3 &'~',g /C C? (; / '7-,:" DEPTH OF WELL ,,.; · ? .... ~ ,..',a ~,( ._. 7 ~ c2 ,~ t; /~ ,. -,.,. STATIC LEVEL OF WATER FT. ADDRESS ~/~ ' LEGAL DESCRI~ION z:..~ ~ ? /~:~k" ?t ,' ~: ; DRAW DOWN FT. 7 /, %,,.~: _" Ended '~ GALS. PER HR (:' DATE- Started ~,: , - · ~/// 0/ PE~IT NUMBER KIND OF CASING L': 7f'~ KIND OF FORMATION: From ,, Ft. to .,~' Ft, From ,,, Ft. to / $~_. Ft. From / ~i~ Ft. to ~:~' 7~ Ft. From · ) Z, Ft. to t .~',:~Ft. From ,' -: ~ Ft. to i ~ ~- From Ft. to , Ft. From_ ." ~ ' ~ From ,': ~;/~;i:', Ft. to/~ ~f ~ Ft. From~Ft. to Ft. From/i,': )~ From .:2.:. ~,, Ft, to ~ , ,~, Ft. From~Ft. to Ft. From ~ ~'?' Ft. to ~?~"'Ft. From ' ', !:~.Ft. to ~)? ! Ft. From__ Ft. to Ft. From _/ / i Ft. to d~OFt. From Ft. to _Ft. From Ft. to Ft. From Ft. to__ Ft. From Ft. to Ft. From Ft. to .Ft, From. Ft to From__ Ft. to FL From Ft. to . Ft. From Ft. to . Ft. From Ft. to . Ft. From Ft. to .Ft. ;Tgia"2"-?q'~ Cr'g~ . .Ft. to .Ft. From Ft. to .Ft. Ft. to Ft. Ft. to.~Ft, Ft. to Ft. Ft. to Ft. Ft. to ,Ft. From MISCL. INFORMATION: DRILLER'S NAME MUN CIPA'ITY OF ^.CHORAGE / DEPARTMENT OF HEALTH & HUMAN SERVICES ~ DIVISION OF ENVIRONMENTAL SERVICES CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4744 H87-0576 Application Date GENERAL iNFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 7 Block 2'Peters Gate Subdivision (T15N R1W Section 14) Location(addressordirections) Sierra Mesa Cr. (b) Property Owner A.H.F.C. Mailing Address 235 East 8th Telephone: Home Avenue, Anchorage 99501 Business (c) Lending Institution lst'National Bank of Mailing Address_ Eaqle River, Alaska 99577 (d) Real Esta[e Company and Agent Linda Malone, Re/Max Address 16600 Centerfield Drive %201, Eaqle River, Alaska 99577 Telephone 694'4200 Mail the HAA to the followina address: or: Check here []~if hold for pick up. List contact person and day phone number below. S & S Engineering 17034 Eagle River Loop Road #204 Eagle River, Alaska 99577 (e) ., TYPE OF RESIDENCE Single-Family ~x Number of Bedrooms three(3) WATER SUPPLY Individual Well I~x Community [] Public [] Note: If community well system, must have written confirmation from 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 1 of 2 72-025 IRev 8/86~ Front ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. S & S Engineering Telephone 694-2979 Name of Firm Address 17034 Eagle River Loop Road #204, Eagle River, Alaska 99577 Date November 21, 1987 NOTE: Engineer's Seal The mound system approved and installed on this lot was designed for the sand fill layer and not the accepting It appears to be functioning adequately at this time. soils. DHHS APPROVAL Approved for three ( 3 ) bedrooms by Approvee~XXXXXXXXXXX Disapproved Terms of Conditional Approval Conditional .December 1, 1987 CAUTION 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 DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 fRev 8/86) Back C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed "~ ""'7..~\ - ~;~"~ Width of Field Square Feet of Absorption Area Depression over Field (Y~) Results of Last Adequacy Test Separation Distance from Absorption Field: t To Water-Supply Well To Building Foundation / Lot "¢'"~ Type of System Design Length of Field ¢7 ~ Depth of Field ~' Gravel Bed Thickness (,/~-~ Standpipes Present~) Date 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 To Cutbank (if present) Comments Do Date Installed "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Pump Off" Level at  puVent (Y/N) -~~~' Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have chec[~.e.d, verified, or conformed to all MOA and HAA guidelines in ~. S, &S ENGINEERiN~ ~'g nea-- $4 E~,-;~ ~.~.---'- ['~PRea'4 N'"'' 2n~ate .~//'/¢-~/"~ Com~ Ri¥~;, Alaak' 995~9' MOA No. Receipt No. ~ --O ~) / -- O (--.J ,/3 Date of Payment ..//f f 02 ._;;~ ~ ~7 Amount: $ /'O ~ Page 2 of 2 72-026 (11/84) effect on the date of this inspection. Src~'V~("c~MBA'~"'FR AUTHORITY APPROVAL (HAA) CHECKLIST - FEBRUARy 1984 WELL DATA 2 Well Classification 264-4720 Legal Description: If A, B, C, D.E.C. Approved (Y/N) Well Log Present ~N) y Date Com~/leted Total Depth '~2.~/ Cased t~"~:>/~r' DePth of Grouting Static Water Level .~[.,o~/~ Casing Height Above Ground Electrical Wiring in Conduitd~J)N) y Separation Distances from Well: I To Septic/~Tank on Lot Yield Pump Set At Sanitary Seal on Casing ~N) y Depression Around Wellhead (Y~;[~ · On Adjoining Lots ; On Adjoining Lots To Nearest Edge of Absorption Field ~.~/~_ot ~ ~ To Nearest Public Sewer Line /J~' To Nearest Public Sewer Cleanout/Manhole ~/.&' To Nearest Sewer Service Line on Lot Water Sample Collected by ~--~' ~ ~:::~-~/-~.~.~,~¢~:9..~, ;Date \\~ \L~,.- Water Sample Test Results ,~,,,~\~-~)~.~:~. ~ .....~,,.~~ Comments ~ '~¢ ~' \_ _~,....4.~ '~k--c~P ~ ~ ~ ~.\-"~\'"'~"/ B. SEPTIC/H~B~4~I'TANK DATA Date Installed 'I//'?....~,/~ -/ / Standpipes ~N) y Air-tight Caps(~N) Depression over Tank (Y/~) Pumping/Maintenance Contract on File (Y/N) //~ Holding Tank High-Water Alarm (Y/N) Separation Distances from Septic~ Tank: To Water-Supply Well \ \~"~ To Property Line ~ c:, t ..~ To Water Main/Service Line Course ! (:~l::;:>~ Jr- Comments Size t, ~ No. of Compartments Foundation Cleanout(i~) Date Last Pumped t-5/jk ; for '-'-- Temporary Holding Tank Permit (Y/N) To Building Foundation To Disposal Field To Stream, Pond, Lake, or Major Drainage Page 1 of 2 72-026(11/84) APPLIC IT FILLS OUT UPPER HAL NLY 'r: :~ Zip Code Realty Co. & Agent Phone Address Zip Code Type of Residence ' -' / ' SingleFamily : Multiple Family No. of Bedrooms ..,' : Other Water Supply ~~ ~:lndividual ~ ~-~' ATTACH WELL LOG A well log is required for all wells drilled since June 1975. ~ Community~CX'~;'~' For wells drilled prior to that date, give well depth (attach log if available). : Public Utility Sewer Disposal ~dndividual Year Individual Installed: ~ Public Utility When Connected to Public Utility: : Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH RE~EST BEFORE ~OCESSlNG CAN BE INITIATED. Inspector I n s pect or,,~ ~__ Inspector ~, Inspector / ~ Soils Rating Date ~wer Inst~lled Well To Absorption Area ~ Well Log Received __ ~ ~ ~ Z f": ~ ~ WelltoTank I [ 3 Septic T~k Size 72-023 (3182)