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HERITAGE PARK BLK 1 LT 4
Heritage Park Block 1 Lot 4 #050-211-32 Municipality of Anchorage '''•. ;\ Development Services Department Building Safety Division On-Site Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page of www.ci.anchorage.ak.us (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SW.090197 PID Number: 050-311.32 Nuns Wastewater System: ❑New ❑Upgrade Addrs.e' ZADITION AVE EAGLE RIVER. AK 99577 ABSORPTION FIELD PhW`* Nunt,ar of BadrOoma' ® Dew T1M1CfI D SnMiow TreMl ❑Bed O Mount D OMM' LEGAL DESCRIPTION Sod RaengEXISTING TOWDepMeomoriginal grade GPE)*e F t. BMca LM sat di. n D." M ppa calam ft" Wig" grade G'.wl depol Ean.aM Ppa 1 4 HERITAGE PARK Ft. Ft To.VIaNp Rupe: sectwm Fe addad above orlg"al grade Gravel Lonyrn Ft. Ft. Well: ❑ New ❑ Upgrade Growl endo! Number M lawn Dwunce IM.een Imo I FL Ft clue 1. 1Prlvaim. A B. cl TOW DeplN Cased to Taal a x,Wi :on arae P.P. Maluwl PUBLIC WATER Ft. Ft Fr 1 3034 PVC Drager Date DMiad SM14 water Level InstMMr Date Inatuled: Ft JR PUMPING 1 1112/2009 VroW'Pump sat at C.00N.pld Maw Ground TANK GPM FL Ft. SEPARATION DISTANCES ® Septic ❑ Holding ❑ S.T.E.P. ❑ Other: To Septic Absorption Lift Holding ublic/PRvate eve lGVla! IY From Tank Field Station Tank Sewer tine Anchorage Tank 1250 GM wog NIA N/A - NIA Mmnal Steel Numbs M Ca pMMwnw 2 svd**wM.r 100+ 100+ - LIFT STATION 10+ 10+ . , Lot fans Gal Fwndanon 5+ 10+ . Punp w- IevM at -Pump W MVM .1Highcaner "M n N M M. 100+ 100+ Pump Maas a MOdel Elect'" M.pecedM wunm l br CunMn Drun Remrw SEPTIC TANK REPLACEMENT NEW 12508 TANK INSTALLED; BENCH MARK Loulwn w Demenptan EXISTING TANK ABANDONED PER CODE. DECK A R Aa.umed MV.edr, 100.0 Ft Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLC Dates: 1" 111212009 2nd 1112/2009 4 `p-\l••�••�, Development Services Department Approval : �.•'' 4i _ � tie 49L"- ; Conditional Approval Date: ,,,, ............ • ��'.':.Steven R. Ponnone?jr Pi �• 3 `�/ D CE 8149 %�NcG All �0 ��' Reviewed and approved by: Date: •.`a 444551�� Om.. amei AREA DEVEL PED NO WELLS /IN 200 FT. SWING TIES =0A B T1 13.2 15.4 157. T2 5.1 1 22.8 / 15% 5% / SEPTIC 20.0 AREA / \ E ISTING TANK IN FAILURE a 64.0 BANDONED PER CODE 5% DECK NEW 1250g SEPTIC TANK / �� INSTALLED WITH DCO T2 7.0 CONNECTED TO EXISTING f T1 5% SEPTIC 1 / AREA 5% EXISTING 4 BR HOUSE \\``% / ON CITY WATER SYST 5% TRgDiTiO \` OF \ 70I0fi% NOTE: THIS IS NO AN AS—BUILT SURVEY. LOCATIONOFHOUSEAPPROXIMATE E C, P•0, 'C 0. AC. 5111 ate 011/4/09 RECORD DRAWINNOTG: BOX01O ANCHORAGE, 995101 �'tP'• '� Scale PHONE (907) 272-8218 fAX (907) 272-8211 j * •49 TMI */// •• %" / bteven nna,,e j CE 8149 . ft� (s ' 1�1j�` 1 =50 HERITAGE PARK S D / BLOCK 1 LOT 4 PAUL ANDERSONIIq 10657 TRADITION AVE. NO P.LD.11 50-211-3?� PERMIT N0. SWO90197 PLAN Sh1 eOF EAGLE RIVER, AK 99577 2 SPECIAL PROVISIONS TO SPECIFICATIONS 1. ALL CONSTRUCTION SHALL BE INSTALLED AS SPECIFIED IN THE MOST CURRENT EDITION OF THE MUNICIPALITY OF ANCHORAGE STANDARD SPECIFICATIONS (MASS) FOR COMPONENT PARTS AND MATERIALS USED IN CONSTRUCTION OF ON—SITE WASTEWATER DISPOSAL SYSTEMS. 2. ALL WORK SHALL BE IN ACCORDANCE WITH THE ATTACHED SPECIFICATIONS. 3. SCOPE OF WORK: NEW 1250g SEPTIC TANK, ABANDON EXISTING TANK PER CODE, CONNECT TO EXISTING TRENCH. 4. GROUNDWATER IS NOT EXPECTED TO BE ENCOUNTERED DURING EXCAVATION, AS EVIDENCED BY THE SOIL TEST HOLE INFORMATION ABOVE 20 FT. IF AN APPARENT WATER TABLE IS OBSERVED IN ANY OF THE EXCAVATIONS LESS THAN 14 FEET BELOW EXISTING GRADE, NOTIFY THE ENGINEER IMMEDIATELY. 5. EXISTING TANK SHALL BE ABANDONED IN ACCORDANCE WITH THE CODE BY PUMPING, CRUSHING, AND FILLING WITH COMPACTED CLEAN EARTH MATERIAL. 5 O z z 0O o o0 U Z z z w J 0'Q�` CI � U U U U O O 98.9 94.7 NEW 1250 g SEPTIC TANK DESIGN PARAMETERS ABBREVIATIONS LEGEND SEPTIC TANK REPLACEMENT: CU COPPER ----w—w WATER LINE/ 1250 GALLON SEPTIC TANK DIP DUCTILE IRON PIPE WELL RADIUS INSTALLED TH TEST HOLE EXSITING TANK IN FAILURE FC FOUNDATION CLEAN OUT — — cs — EXIST'G SEPTIC ABANDONED PER CODE T# TANK CLEAN OUT N0. C# CLEAN OUT NO. — u — ss — NEW SEPTIC M# MONITOR TUBE NO. R.I. RIGID INSULATION — 0 CHAINLINK FENCE DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FSS FLOW SPLITTER NOTES: T T e L L PANNONE ENG SVC, Q.. P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 —�pF A�q\�1 �%tp� • ' !S� 41 its• 9 /OF 'teven R:'Panri)me 'j CE 8149 � ('?h�Tl �1��� Dote 11/4/09 RECORD DR Scale NTS HERITAGE PARK S/D BLOCK 1 LOT 4 PAUL ANDERSON,I�SJ 10657 TRADITION AVE. EAGLE RIVER, AK 99577 50-3N1 3 PERMIT No. SW090197 DESIGN NOTES Sheet 2 of 2 `��� MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water d Wastewater Program 4700 South Bragaw Street P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-7904 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT Upgrade Date Issued: Oct 01, 2009 Expiration Date: Oct 01, 2010 Permit Number: SW090197 Parcel ID: 050-311-32 Legal Description: HERITAGE PARK, Bt, L4 Design Engineer: 0062 PANNONE ENGINEERING SERVI( Site Address: 10657 TRADITION AVE Owner Name: PAUL ANDERSON Lot Size: 0 SO. FT. Owner Address: 10657 TRADITION AVE Total Bedrooms: 0 Permit Bedrooms: 4 EAGLE RIVER. A 99577 - This permit is for the construction of: ❑ Disposal Field ❑,/ 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: / Date: e Municipality of Anchorage Development Services Department Building Safety Division / On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, Alaska 99519-6650 www.muni.org/onsite (907) 343-7904 ON-SITE SEWER/WELL PERMIT APPLICATION FOR A SINGLE FAMILY DWELLING Parcel I.D. 0S0 — 21 / — 32 Property owner(s) PfM& t_ firy015g Teri Day phone Mailingaddress /u &57 7-r-rt-ornar.: "G trA&rFr-iipCode `)9x7-7 Site address Sn Zip Code Legal description (Sub'd., Block & Lot) /�a�, 0i P- /r s/o 8!r i (ter c/ Legal description (Township, Range & Section) Lot Size Sq. Ft. Number of Bedrooms V THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN: Absorption Field ❑ Initial ❑ Septic Tank ® Upgrade [ Holding Tank ❑ Renewal ❑ Privy ❑ Private Well ❑ Water Storage ❑ 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. Pannone Engineering Services, LLC (Signature of property owner or authorized agent) Permit/Rush Fees: 4�-3 40 Waiver Fees: Date of Payment: / o - / — t7 `i Date of Payment: Receipt Number: �j z 2 !� Receipt Number: (Rev. 11/05) Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: stevePpanenzak.com October 1, 2009 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: Heritage Park S/D Block 1 Lot 4 Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new septic tank be issued for this lot. The proposed systems will serve an existing four-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a four-bedroom house and is operating adequately for four bedrooms. The existing tank is in failure. The surrounding lots are served by public water systems and there are no wells within 200 feet of the proposed septic tank. This lot is served by public as well. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. Number of Bedrooms: 4 b. Septic Tank Size: 1,250 gallon 2. Surface Nater: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 4 slopes to the southwest at approximately 15 percent on the northern lot boundary which decreases to 5 percent in the area of the septic system and house. The proposed installation will be located in the central portion of the lot next to the existing septic tank and absorption system. Mailing: P.O. Box 102954, Anchorage, AK 99510-2954 Physical: 11301 Olive Lane, Anchorage, AK 99515 Telephone: (907) 272-8218 FAX: (907) 272-8211 Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely, Steven R. Pannone, P.E. Owner/Civil Engineer Attachments: Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 11301 Olive Lane, Anchorage, AK 99515 Telephone: (907) 272-8218 FAX: (907) 272-8211 AREA DEVEL PED NO WELLS /IN 200 FT. 15% f 15% 20.0 SEPTIC 5% E ISTING TANK IN FAILURE AREA 64.0 BANDON PER CODE 5%INSTALL NEW 1250g SEPTIC TANK WITH DCO 14.0 CONNECT TO EXISTING FIE 5% SEPTIC / AREA 5% f EXISTING 4 BR HOUSE ON CITY WATER SYST r, /5% o Uru I FOR RE'v EI I PANNONE ING SVC, LLC P.O. BOX 100217 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 HERITAGE PARK S/D BLOCK 1 LOT 4 PAUL ANDERSON PLAN 10657 TRADITION AVE. EAGLE RIVER, AK 99577 *,• QQ *�I� S10 eo et/09 1'_50wnPin mn -2t1-3 Steven nnogej PERMIT N0. �. CE 8149 .��� Swzzxxxx '� ✓ATO�ES4���G Sheet 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 PHONEI J<NEW _ L7 �� GTIDE�;?41 ❑UPGRADE MAI LING ADDRESS •r ! eat s LEGAL DESCRIPTION `t--�� G 0 PA 511113p - LOCATION NO. OF BEDROOMS Vt7Z Well Absorptionareq Dwelling a PERMIT NO. Uy DISTANCE TO: fir- 1N F Z Manufacturer Material No. of compartments aQ LU I_ m Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth Well Dwelling - PERMIT NO. Oz 02 DISTANCE TO: _j —Z< Manufacturer.t� Material Liquid capacity in gallons /`- O Well Foundation t Nearest lot Hne,,, i PERMIT NO. w = DISTANCE TO: 'T' -213 J LL Z No. of lines Length of each I e r Total lengt o ..li es, Trench width Distance between lin s — Z w inches F --K F- Top of tile to finish grade 7 Material beneath the - 60 Total effective absorption area inches Length Width Depth PERMIT NO. LU Q H Type of crib Crib di ,{er Crib depth Total effective absorption area m a w �� w Well Building foundation Nearest lot line y DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. J LU Building)6urift&fion Sewer line Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS 3f7 �jPGt -TZ� PIT Pio N. PL rn/ lT SOIL TEST RATING INSTALLER ug QLatoe-7- REMARKS L A A1C- 0 ®®a o SS JOHN E. SWANSONa w ®� •° I ®'� lk_�9 "ROFESSMtk!�_ ®� T a APPROVE DA E LEGAL 00 71 72-013r(Rev. 3/78) 1 -IV I.1 V i I I♦ .. Department f Health and Env iron menta ' Protection r 825 \� L' Street, Anchorage, AK. \-�/9501 264-4720 HANDWRITTEN PERMIT Permit #M)[�i) 1 HANDWRITTEN SEWER PERMIT Applicant: eo_j,44 retie'✓ Mailing Address: `7/a C�(d Location: -T Phone Number: 3 (/ 2- (o Legal Description: �( / %%ehOL�Z ��- Lot Type of Soil Absorption System Is: Trench: u Drairifield: Seepage Bed: Maximum Number of Bedrooms:_ Soil Rating(sq.f Size: Holding Tank: t/br) /.;? S The Required Size of the Soil Absorption System Is: 01 'DEPTH LENGTH (03 GRAVEL DEPTH WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). * * REQUIRED SEPTIC(HOLDING) TANK SIZE _ ���D 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 department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 31, 1 9 u 3 # # # I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I will install the system in accordance with codes. (3) I understand that the on-site sewer system may require enlargement if the residence is remodeled to include more that X bedrooms. Signed:�Issued by: Applicant Date: ,-!� SWP/024(1/81) &* ENGINEERS, INC. ate":•1'��::" i, 7125 OLD SEWARb-_-HWY. ANCHORAGE, ALASKA 99503 34976561 SOILS LOG PLRCOLA[ION ITSI 12 Date '�—��iK..__' PI-I{F UItMf-0 FOIL-// _.. 1� 0 e• e�0 LEGAI. DESCRIPTION _J<../e-r 14 t • o'-�' F-ozekt Ot�dLV, I .IO N SI 1¢ 1.0/5004e- SOI_LlA , o• / / relcet 6r0.vG 1 2 °. A6eCe :* 3 �•c O r 50..K� /rzrzrGI C -e �o .So M•t c� 5 A _ 13 G, ave l w� SeM+E i.o? 6 %�°oo S4 a %race S,'�+ a o A)oKe� Da 5cca,} / Colobkea 7 D'o D o 6 160 ,�AerS G�0.�/ 6rvv-51ti 8 O. GW -GP 12 Date Gross Time Net Time OO . ar 1� 0 e• e�0 )*3 14 t ®®®®®®®®® ®�tpF q4ry AA�(1 15 o/ Ole--a•se �� a eees� 1 ��e 16 ®® A6eCe :* 1 7 9� JOHN E. SWANSON°: t a s °ee 1834-E ; e �F9�cQe°°ecce°°°°° 19 ®� p90FESSI0%t,W 20 t_ COMMENTS_ PERFORMED BY: D I'LRCOLAr1ON ILSI Z/ sedCrooat.iS IIA 11 PI III OHMEI.1 WAS GROUND WATER ENCOUNTERED? IF YES. AT WHAT DEPTH? S L O P lu-k— E rie �s�d` �irth /eJ t - r Reading Date Gross Time Net Time Depth to Water ar Reading Date Gross Time Net Time Depth to Water Net Drop PERCOLATION RATE Vj (, 6d VV re. > -_(minutes/inehl TEST RUN BETWEEN FT AND --L--- FT CERTIFIED B j E: MUNICIPALITY OF ANCHORAGE� Development Services Department Phone: 907-343-7904 On -Site Water & Wastewater Section Fax' 907-343-7997 Certificate of On -Site Systems Approval Parcel I.D. 050-211-32 Expiration Date: /' , 1. GENERAL INFORMATION Complete legal description Heritage Park Sub, Block 1, Lot 4 Location (site address) 10657 Tradition Ave Current property owner(s) Jeb & Jennifer Ritchie Day phone (302) 670-9742 Mailing address 10657 Tradition Ave, Eagle River, AK 99577 Real estate agent 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) --------❑---Duplex ---- ------------ ❑ Multiple Dwellings (Single Family and/or, Duplex) 3. NUMBER OF BEDROOMS: 3 Day phone 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Private Well ❑ Private Septic 0 Water Storage ❑ Holding Tank ❑ Community Well ❑ Community ❑ Public Water System 0 Public Sewer ❑ Waiver request for: Distance: Received by: Date: COSA to be released to the engineer, unless otherwise requested by the engineer. S 5 0 t COSA Fee $ Date of Payment 5 7 a o2 Waiver Fee $ Date of Payment Receipt Number Q2 G% 5 Receipt Number COSA # 05C-211 2 2 S Waiver # N ji 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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. I acknowledge that On -Site staff may visit the site to verify the information submitted. Name of Firm Forge Engineering Phone (907) 522-7773 Address 1399 W. 34th Ave Suite 101, Anchorage, AK 99503 Engineer's Printed Name Benjamin Schiller. Date 5/5/21 of ACq�l�t co - TH / - *r �. .. _,.p. .� 6. DSD SIGNATURE .., . System #1 Approved for 3 bedrooms r Beniamav chiller / System #2 Approved for bedrooms CE 12592 Disapproved ll`EOpROFESSOOO Conditional approval for bedrooms, with the following stipulations: os Wp,TER AND o S WAo�r,F. AM F � S))illl���,,! By: Original b y g al Certificate Date. The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA Checklist blue sheet COSA Checklist Legal Description: Heritage Park Sub, Block 1, Lot 4 Parcel ID: 050-211-32 If more than 1 septic system on lot: COSA Checklist # of Structure served by this system A. WELL DATA og is filed with Onsite (or attached) Date drilled Total depth ft Cased to ft ❑ Sanitary seal is functioning correctly ❑ Wires are properly protected Casing height (above ground) in. Date of flow test for COSA Static water level at beginning of test Comments ft. B. TANK DATA Age of tank(s) 12 years Tank type/material Septic/Steel Measured operating fluid level in septic tank 54 ---- 0 Standpipes/foundation cleanout per record drawing Date of pumping 5/5/21 JR Pumping D. ABSORPTION FIELD DATA Wide Trench Which system tested (date installed) 3/1/83 A ALL standpipes present per record drawing Total measured depth from grade 7.4 ft (max) Measured depth to pipe invert from grade 3.4 ft (min) ❑ N/A — pressurized field ❑ Monitor tubes go to bottom of effective. If not, state depth into effective 4' Q Code -required soil cover over field ❑ System presoaked (Required if vacant for greater than 30 days prior to date of test) Gallons introduced gallons Comments/Deficiencies: COSA Checklist yellow sheet Well production at time of test gpm Water storage tank volume gallons Well disinfected for coliform test? ❑ Yes ❑ No ❑ Coliform bacteria is Negative Nitrate mg/L ❑ Nitrate less than MRL (ND) Arsen ug/L ❑ Arsenic less than MRL (ND) Collected by Date of Sample C. LIFT STATION maintenance completed Age of lift statio7�_�years Lift station material Comments: Adequacy test date 5/3/21 Results Q✓ Pass For 3 bedrooms Fluid depth prior to test 34 in Water added 523 gal New depth 40 in Elapsed time 1440 min Final fluid depth 34 in Absorption rate '450 gpd Any rejuvenation treatment (past 12 months) If yes, enter date E. SEPARATION DISTANCES From Private Well on Lot to: (Please enter distances if less than required or if community well) ❑✓ Septic Tank/Lift Station on Lot > 100' N/A Community Sewer Manhole/Cleanout > 100' N/A ❑ Yes if No ft p Yes if No ft Neighboring Tank > 100' ❑ Yes if No N/A ft Private Sewer/Septic Line > 25' ❑ Yes if No N/A ft Absorption Field on Lot > 100' ❑ Yes if No N/A ft Holding Tank > 100' ElYes if No N/A ft Neighboring Absorption Fields > 100' N/A Animal Containment > 50' ❑ Yes if No N/A ft ❑ Yes if No ft From Absorption Field on Lot to: (Please enter distances Manure/Animal Excreta Storage > 100' Community Sewer Main > 75' [:1 Yes if No N/A ft ❑ Yes if No N/A ft From Septic/Holding Tank on Lot to: (Please enter distances if less than required) Building Foundations > 10' ❑ Yes if No 7 ft Surface Water > 100' Yes if No ft Property Line > 5'✓❑ ❑✓ Yes if No ft Wells on Adjacent Lots: Absorption Field > 5' ❑✓ Yes if No ft Private Wells > 100'✓❑ Yes if No ft Water Main > 10'✓❑ ❑✓ Yes if No ft Community Wells > 200'✓❑ Yes if No ft Water Service Line > 10' 0 Yes if No ft If septic tank is under driveway comment below From Absorption Field on Lot to: (Please enter distances if less than required) -- Building -Foundation ->-10' - ✓❑ Yes---if-No-- ft-----If-absorption-field-is-under-driveway-comment-below- Property Line > 10' ❑✓ Yes if No ft Wells on Adjacent Lots: Water Main > 10'✓❑ Yes if No ft Private Wells > 100' ®✓ Yes if No ft Water Service Line > 10' ❑✓ Yes if No ft Community Wells > 200' ❑✓ Yes if No ft Surface Water > 100'✓❑ Yes if No ft F. ENGINEER'S COMMENTS G. ENGINEER'S CERTIFICATION 1 certify that 1 have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. COSA Checklist yellow sheet IF .r 49TH •*� Benlarn�sr Schiller r� �F� • . , CE 12592 • �`��� �J'J�. • . , 5/5/21 . • '�G�� pROFESSI0�A4 Municipality of Anchorage On -Site Water & Wastewater Program = 9 (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL 2l l Parcel I. D. 050-2.2i-32 Expiration Date: 1. GENERAL INFORMATION Complete legal description HERITAGE PARK BLOCK 1 LOT 4 Location (site address) 10657 TRADITION AVE. *EAGLE RIVER 99577 Current Property owner(s) ELIZIBETH JENSEN Day phone 360-7161 Mailing address Real Estate Agent Day phone 2. TYPE OF DWELLING: E Single Family (w/wo ADU) F-1DuplexDuplex SURM, ❑ Multiple Dwellings (Single Family and/or Duplex) AUG 2 l 2094 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WAST EIAIATER AtSQySAL Individual Well ❑ Individual On-site Individual Water Storage ❑ individual Holding tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System 0 Public Sewer ❑ WaiverNariance request for: n/O Distance: — COSA to be released to the engineer, unless COSA Fee $ 52 ro —j Date of Payment Receipt Number o�0�13 G COSA # �G ►� i�I Waiver Fee $ _ Date of Payment Receipt Number Waiver* S. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, 1 verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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. 6. DSD SIGNATURE System #1 Approved for 3 bedrooms. System #2 Approved for Disapproved. Conditional approval for bedrooms. Phone 337-6179 Date f3 t q Ac bedrooms, with the following stipulations: OF CE -79 3 f to f e s slolioc ON-SITE WATER AND �g WASTEWATER o1 _ PROGRAM Original Certificate Date: j L ( - The Wicipa)i(y oKAn&7'0rage Develop, emt Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the represenatations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. ATTCHMENTS: COSA Checklist Septic System Advisory Well Flow Advisory (Rev. 11 N6) Nitrate Advisory Arsenic Advisory Other If more than 1 septic system is on the lot: COSA Checklist # of Structure served by this system Certificate of On -Site Systems Approval Checklist Legal Description: HERITAGE PARK BLOCK 1 LOT 4 A. WELL DATA Well type Date completed Total depth ft. Date of test Static water level AWWU WATER If A4 B, or C provide PWSID# _ Sanitary seal (Y/N)_ Cased to ft. FROM WELL LOG Well production _ WATER SAMPLE RESUL Coliform 00 ml. Nitrate ft. 9-p M. 2111 Parcel ID: 050—QQ14 —32 Well Log (YIN) _ Wires properly protected Casing height (aboyegri AT mg./L. Collected by: ug./L. Date of sample: B. SEPTIC/HOLDING TANK DATA M. in. Tank Type/Material SEPTIC/STEEL Date installed 11/2/2009 Tank size 1250 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 8/5/2014 Pumper JR'S C. ABSORPTION FIELD DATA *BELOW EXISTING GRADE Date installed 3/1/1983 Soil rating (g.p.d./ft`or � 125 System type SHALLOW TRENCH Length 64 ft. Width 6 ft. Gravel below pipe 5 ft. Total depth *7.25 ft. Eff. absorption area 640 ft2 Monitoring tube **YES Depression over field NO Date of adequacy test 8/6/14 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 18_75 in. Water added ***1127 gal. New depth 28 in. Elapsed Time: 221 min. Final fluid depth 24.5 in. Absorption rate >= 450+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) NONE If yes, give date — **MT ONLY EXTENDS TO 53.25 INCHES BELOW INVERT ***THE LAST 560 GALLONS INTRODUCED ONLY CAUSED A RISE OF 3.5 INCHES D. LIFT STATION Date installed Size in gallons Manhole/Access (YIN "Pump on" level at in. "Pump oft" leveler High water alar level at Cycles tested Meets alar & circuit requirements? E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tankAtft station on lot Absorption field on Public sewer main Sewer /septic service line Animal n areas On adjacent On adjacent lots manhole/cleanout Holding tank Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5'+ Property line 5'+ Absorption field 5'+ Water main 10'+ Water service line 10'+ Surface water 100'+ Wells on adjacent lots N/A SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Properly line 10'+ Building foundation 10'+ Water main 10'+ Water service line — 10'+ Surface water 100'+ Driveway, parking/vehicte storage 10'+ Curtain drain NONE KNOWN Wells on adjacent lots N/A F. COMMENTS See— 1— TVE¢ Frz r ci 2 5 St 's G Pu t Pi S b f U.0 G. ENGINEER'S CERTIFICATION that I have determined through fleld inspections review of Municipa records that he above systems are innd Vconformance with MOA COSA guidelines in effect on this date. ...Ga es......Engineers Printed Name JEFFREY A. GARNESS795Date $ I j'q��F°Ad�a (Rev. 11/05) tc1 d 4Rtill T 622enu & Ab6uulA:fES LAND SURVEYING 694 I HEREBY CERTIFY THAT I HAVE SURVEYED THE SCALE; , FOLLOWING DESCRIBED PROPERTY; i - �-0:14, OF A ®am$ W6 DATE; ��© Y63f' / AND THAT NO E.NCROACHMEN`fS EXIST EXCEPT AS �� •' Sfq INDICATED. IT IS THE RESPONSIBILITY OF THE y r� �� GRID; OWNER TO DETERMINE THE EXISTENCE OF ANY EASEMENTS, COVENANTS, OR RESTRICTIONS ilii ss N WHICH DO NOT APPEAR ON THE RECORDED SUBDI- VISION PLAT. UNDER NO CIRCUMSTANCES SHOULD f� ......Duane MErk wa o FB- B ANY ANY DATA HEREON BE USED FOR CONSTRUCTION OFFENCE LINES, OR FOR ESTABLISHING BOUND- DRAWN; 1; ARY LINES. lJiisf $� as u $a.•.�Ee+� _ JR'5 5EPTIC PUMPIAIG UC P•O•BOX 773875 EA61,E, RIVER AK PHONE # 694-6454 99577 FAX 34,f-9&17 DATE: 8/17/14 TO WHOM IT MAY CONCERN. SUBJECT: PROPERTY LOCATED AT 10657 TRADITION AVE EAGLE, RIVER AK HERITAGE PARK S/D BLOCK 1 LOT JR'S INSTALLED A NEW 1250 STEEL TANK ON 11/02/09 THE TANK WAS INSTALLED TO M.O.A. CODE. DUE TO LACK OF COVER THE TANK WAS INSULATED WITH 2 INCHES OF 60 P.S.I INSULATION BOARD AND COVERED WITH 2 % FEET ON SITE MATERIAL. WITH NEW DOUBLE CLEAN OUTS AFTER TANK. JR'S IC P,U�PING LLC 7 DAVID E MERG PRESIDENT. Municipality of Anchorage t�lppE BL z •; Development Services Department Building Safety Division c On -Site Water and Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. 050-2112 COSA# SSC S"al"�yf'1� Expiration Date: I LZ 1. GENERAL INFORMATION Complete legal description Heritage Park Blk i Lt 4 Location (site address) io6c7Tradition Ave. Eagle River Ak. 44577 Current Property owner(s) Paul Anderson Day phone Mailing address io657Tradition Ave Eagle RiverAk 49577 Lending agency Day phone Mailing address Real Estate Agent Day phone Mailing Address --- -Unless-otherwise-requested,, C -OSA -will be held -by -DSD for pickup, 2. NUMBER OF BEDROOMS: 3 3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ❑ Individual On-site Individual Water Storage ❑ Individual Holding Tank ❑ Community Class Well ❑ Community On-site ❑ Public Water System ® Public Sewer ❑ The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 4 by an independent professional civil engineer registered in the State of Alaska. Certificates of On -Site Systems Approval are required for the transfer of title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water supply system. DSD also issues COSAs upon request to homeowners. Certificates of On -Site Systems Approval are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued with new water sample results. (Certificates may be reissued for a period of up to one year with valid water samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 4. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage 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 Pannone Engineering Services, LLC Phone 272-8218 Address _P.O. Boxzoozi7 Anchorage AK ggrio Engineer's Printed Name Steven R. Pannone, P.E. Date t72o9 Engineers Comments: In conducting an adequacy test, I attempt to provide a thorough, conscientious engineering analysis of the system in accordance with MOA DSD Guidelines & Regulations. The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. .""���1 The operational life of all wells and septic systems depend on the local soil condition, ground water �J� QF levels that may fluctuate during the year, and the water usage of the family being served by the system. ���P...... •' •... .. These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system, nor do they guarantee that g m there are no hidden defects or encroachments. PES can therefore not provide any warranty for future a ...... �•• ••• ••' ••• •• ••••••s••••y performance nor give any estimate of how long the system will continue to meet the operational 0i requirements of the MOA DSD. The content of this report is for the sole benefit of the owner listed •%Steven •R. Pa •• above. Any reliance upon or use of this report by any other person or parry is not authorized nor will it �e No. CE 8149 S s confer any legal right whatsoever.,a.''•..,. .••'.� 5. DSD SIGNATURE Ap�ss,�::•� _�z Approved for —3—bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Attachments: COSA Checklist X Septic System Advisory Well Flow Advisory Nitrate Advisory Arsenic Advisory Maintenance Agreements Supplemental Engineer's Report Other By G2✓ Original Certificate Date: (Rev. 11los) Municipality of Anchorage ' Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Bragaw Street P.O. Box 196650 Anchorage, AK 99519-6650 www.muni.org/onsite (907)343-7904 CERTIFICATE OF ON-SITE SYSTEMS APPROVAL C Legal Description: Heritage Park Blk i Lt y A. WELL DATA Well type Public Date completed Total depth ft. Date of test Static w r level ell production ID: 050-211-z2 If A, B, or C provide PWSID # Well Log (Y/N) WATER SAMPLE RESULTS: Coliform colonies/100 mL Arsenic: ug/1 B. SEPTIC/HOLDING TANK DATA ft. 9 -P.M. Nitrate mg/L Date of sample: Wires properly protected (YIN) Casing height (above ground) in. AT INSPECTION Collected by: ft. Tank Type/Material Steel Date installed 22/2/2000 Tank size 225o gal. Number of Compartments 3 Cleanouts (Y/N) Y Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N/A Date of pumping 2� /zZ /rZ Pumper -=T7aS' C. ABSORPTION FIELD DATA Date installed 1/1/3.98:1 Soil rating (g.p.d./ft2 or ft2/bdrm) 225 sf bd System type Trench Length 64 ft. Width 6 ft. Gravel below pipe 5 ft. Total depth 8 ft. Eff. absorption area Geo ft2 Monitoring tube Y Depression over field N Date of adequacy test s/20/2012 Results (Pass/Fail) Pass For 3 bedrooms Fluid depth in absorption field before test o in. Water added-4go gal. New depthzz in. Elapsed Time: 7o min. Final fluid depth o in Absorption rate >= 45o+ g.p.d. Any rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date D. LIFT STATION Date installed "Pump on" level at —in. Datum E. SEPARATION DISTANCES Size in gallons Manhole/Access (Y/N) "Pump off" level at —in. High water alarm level at Cycles tested Meets alarm & circuit requirements? SEPARATION DISTANCES FROM WELL ON LOT TO: Septic tank/lift station on lot Absorption field on lot Public sewer main Sewer /septic service line On adjacent lots On adjacent lots Public sewer manhole/cleanout Holding tank Animal containment areas Manure/animal excrete storage areas SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line ;+ Absorption field 5+ Water main io+ Water service line io+ Surface water aoo+ Wells on adjacent lots aoo+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Property line io+ Building foundation io+ Water main 2.o+ Water Service line ao+ Surface water ioo+ Driveway, parking/vehicle storage io+ Curtain drain 50+ Wells on adjacent lotsoo+ F. COMMENTS 1.W G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and ffv % _` y review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. �........... .... .............. Engineer's Printed Name Steven R. Pannone. P.E. e� .Steven R. onnonegy ♦ E No. CE 8149 S Date !i C/ � a;..... _.,.•�W-.• COSA Fee $ `T � 0 Date of Payment a - 219 - )-?— Receipt 2 Receipt Number t7 0 (o (Rev. 11105) Waiver Fee $ Date of Payment Receipt Number in. M RUG -28-2012 01:35 FROM:JR'S SEPTIC PUMPING 9073449821 T0:272e211 JRs Pumping JY PO Box 773415 Eagle River, AK 99577 (907)694.6454 Service Agreement � Number: Order pate: 22 -Aug -2012 Service Date: 27 -Aug -2012 t9llling Infortion Technician: Mike & Hugh Pannone Engineering JobOeecAptlon: 1000g Po Box 100217 P.O. Number. Anchorage, AK 99510.0217 Terms: Net 30 Tax W 0 (907) 272.8248 salesrep: Dawn -Dawn Job Type: Repeat Off Map Book: Map Grld: 100- - rob Site Information Cross Streets: Eagle River Road _ Melissa Job Comments: Last Service '09107120100 1000g 10657 Tradition Ave 'SERVICE & BILL` Eagle River, AK 99577 (907)847-0926 Additional Location Comments: Diagram: Gallo Cedar home w/ big green garage door w1 house #'s septic In back of home to the right of garage, has fence but is unlocked `Ablv�- tJ��►M1'1'A L C'& D Service Typet Septic Sery 1000K H TWr dta • • • a G;Q dG"Or Qty Price Each Tax? 1 $195.00 No ns Planned: ~lee e IZ50 Gal, Actual: /2;56 Hose Length: 1,5 Double Tank: 0 Pump System: 9 Baffles Inlet: 0 Baffles Outlet:0 Extension Actual $195.00 Non aXable $196,00 $0-00 Taxable e00Tatal Tax I Grand $1 ii 00 Total Eetlmated Charges: `ri JctJ�s l95 ` 19�5- ACIUeI Chafgear Customer agrees to the terms and conditions shown. THIS IS A BINDING AGREEMENT. Signature and ufCerpresentative Dalo Accepted by JRs Pum In Date A cepted For your added convenience we accept; Dlcover, Visa and Master Card payments over the phone. After 30 Days account will be turned over to COLLECTIONS, $30.00 For NSF Checks Returned, MW BY•PACIFIC NX TITLE -AK -;,1-11 0 2:03FM *F f ALAW -%lilt 207 272 8738:1.2t 2 :oia.mn �.a °Q' Ij 3; �r h ! : Of D r 1c3' 1 1t . ESI -17 •` shy.• 'Soar SCALE: PLOT PLAN: ' AS7VjLT: X' JOAM, DRAWN 6Y. Pr- CNECKEO Sy-' . S&S ENGINEERS, INC. 7125 CLIO SEWARD WWi. ANCHORAGE. ALASKA'OSSOA I HERESY CEAS2r'Y IN MAY£ SURVEYED THE Fo6L.OMING DESCRI9S0 PROPERTY. LOT 4 .5t .FiE�i�{ACS �%/l#iK. ANCHORAGE ARCOMING DISTRICT. Ax.+ AND rHAT TME tHPRovEMEMTs stTuATEO TH£REoN Am MITHtN TME PROPERTr LINES+ , of AI_ Itt. ANO DONOT 04CAOACK ON THE PROPERTY LYING ADJACENT TMERETO. THAT NII i„L�.•.+' '+:•'p iHPROVEMENTS ON PROPERTY LTING AOJACENT'VERETO`E741CROACK ON THE PREHSSES ry.a '4• I IH'GUVOTTON AND THAT THERE ARE "0 ROAOMAYS. TRANSNISSIOH LINOS OR OTHER x -„} 11 VZStOLE EASEMENTS ON SASOPROPERTY EXCEPT AS INDICATED HEREON. "'. I. DATED THIS 10thDAY OF LJUNe • 10ft ANCHORA0_ ALASKA. ,\ "ky IT 12 THE RESPONSIStUTY OF THE cwmrA on ounsER, PRIOR TO CONSTRUCTIOt +�'�re+•+�• t +'+� TO VEAtFY PAW"CO 9UIL0INO CRAPE RELATIVE TO FINISH GRAoE AND trrILITY CONHECTIDHS.AND. TO DETERMINE THE EXISTENCE OF ANY WENENTS, COVENANTS tL�phatc ;\ti`fg% OR RESTRICTIIINs WHICH COMOT APPEAR ON THE RECOMED WHOYVZSION PLAY. �J MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date ef¢�5- • f9ad 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) t l3 lese.&c �'eP,lM PaPBi S dIa Location (address or directions) (b) Applicant Name 6F'@k bc4o or Telephone: Home Business ,S"6 3- 3B49S Applicant Address P cp• Se$ 7736/ 2Epyl@ Doves% AW 99.777 (c) Applicant is (check one),Lending Institution ❑ ; Owner/builder IN; Buyer ❑ ;Other ❑ (explain); (d) Lending Institution Telephone Address gv S. wwaec M -e- W' .-v .ire cam ca � ca (e) Real Estate Company and AgentReu &Z cenke'' Address 83 00 Mar T Zell R h,1c oneye 99!P?'7 Telephone 3yA/-0�5'0 (f) Mail the HAA to the following address: 161�1� :ry°' Olek -Cc 2. TYPE OF RESIDENCE Single -Family 29 Multi -Family ❑ Other Number of Bedrooms 3. WATER SUPPLY Individual Well ❑ Community ❑ Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL Onsite ® Public ❑ Community ❑ Holding Tank ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11/84) 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 watersupply 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 F10LAP 9�ecdon°��®P �evv�c� Telephone 3 ejS- "i35S Address 1 °J S3® EFC k) _5;k.1 ;A yr c kon el &r "s -ley" Date v°°°•°°•°•°•°°••°°°••••. * engineer's Seal �s•e•e eooeoeeeeo°seo 0 °e THEOCORE F. MOORE °^ t% 94 CE - 3589 ZY D� 4 �7®®essl _ 's. 6. DHEP APPROVAL � Approved for j bedrooms by ate ! . Approved Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) '* CHECKLIST - FEBRUARY 1984 A yF 264-4720 ' La¢ �I,�314e k 2 l s f'q�3 Legal Description: rte+ t ocwk StD A. WELL DATA Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) Date Completed Total Depth Cased to Static Water Level Casing Height Above Ground Electrical Wiring,in Conduit (Y/N) Separation Distances from Well: To Septic/Holding Tank on Lot To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Yield Depth of Grouting Pump Set At Sanitary Seal on Casing (Y/N) — Depression Around Wellhead (Y/N) On Adjoining Lots On Adjoining Lots — To Nearest Public Sewer To Nearest Sewer Service Line on Lot — ; Date Water Sample Test Results Comments IIer;Fted H2O C*gASCf w. 9/3 186 B. SEPTIC/HOLDING TANK DATA Date Installed 3/1/493 SizeI ZJ'V,7Q r No. of Compartments 2 Standpipes (Y/N) Y Air -tight Caps (Y/N) Y Foundation Cleanout (Y/N) Y Depression over Tank (Y/N) N Date Last Pumped "3 1 &4r Pumping/Maintenance Contract on File (Y/N) N, A. ; for NeA. Holding Tank High -Water Alarm (Y/N) N.A. Temporary Holding Tank Permit (Y/N) ALA. Separation Distances from Septic/Holding Tank: To Water -Supply Well N#A. i P"614c N&.03 To Building Foundation 141* ff'00" C, To Property Line N SfD' To Disposal Field a To Water Main/Service Line ? ld+ Course > ICy Comments Page 1 of 2 72-026(11/84) To Stream, Pond, Lake, or Major Drainage C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 12s' fit' / a ote-o+ Type of System Design Trim e 4 Date Installed 3/1/83 Length of Field 6Y� _.amu _ t Width of Field Depth of Field Gravel Bed Thickness 4!�O it Square Feet of Absorption Area 6 Yd t Standpipes Present (Y/N) Y Depression over Field (Y/N) N Date of Last Adequacy Test 9 l Y /Re Results of Last Adequacy Test AoCeouate J y brefroa ft Separation Distance from Absorption Field: To Water -Supply Well N°N, (Pabl,c NLO) To Property Line 20' To Building Foundation 23' Lot N, A. To Water Main/Service Line a to' To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION N•A. Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes (Y/N) — Comments To Existing or Abandoned System on On Adjoining Lots To Cutbank (if present) foci, Dimensions Manhole/Access (Y/N) 'Pump Off' Level at ** Check Permitted Bedroom Rating Against HAA Request ** Vent (Y/N) Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed :J ;T. Date 914Y16(r Company FlRfe� Tick Sou MOA No. 86' 05'?- Receipt StReceipt No. S 3 Date of Payment 1 �� OF At Amount: $ _�9S �� �,�Q� ® Engineer's Seal TH Page2of2 0' '�..........° Q •THEODORE F. MOORE ; O V CE - 3589 2 . ,y 72-626 (11/84) V �f� °0 • ��� APPLIC NT FILLS OUT UPPER HAL ONLY Property Owner J� �'.1 �7 �/�`— �-= - Phone �, l_, �� L_- (�' • F `' l� i _ Mailing Address v ,fi/ J- /•' Zip Code p J % ;. �� Buyer=- Date Zip Code Address Lending Institution Phone 1 Address l,/./. -;� t.�'L..-1,.-� Zip Code � Phone Agent �� %` � Realty Co. & T,,.»�:=✓'v/1•/t/��-tel_ t - fes/'• __/� Zip Code Address�,. Legal Description : 1 `--1i-- ( , Street Location tJ Type of Residence n,^fmgle Family LI Multiple Family No. of Bedrooms— ( .) APPROVED BEDROOMS C1 Other ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL. Water Supply ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Individual L For wells drilled prior to that date, give well depth (attach log if available). omidunity 4Public Soils Rating Utility Well To Absorption Area Well Log Received Sewer Disposal3 Individual - Year Individual Installed: Public Utility When Connected to Public Utility: ❑ Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date Inspector Inspector Inspector Inspector Field Notes: ,,req JUN 141983 "Municipality of Anchorage" "DOW Of 14PAN & `CONDITIONS OF APPROVAEnvlrorMOri:al Protection" ( .) APPROVED BEDROOMS ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL. DATE L BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Well to Tank Septic Tank Size 72.02313182)