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HomeMy WebLinkAboutLAKE HILL ACRES #5 BLK 1 LT 2Development Services Department Building Safety Division On -Site Water & Wastewater Program 4700 Elmore Road P.O. Box 196650 Mark Begich Anchorage, AK 99507 s c E T T Mayor www.muni.orcl/onsite (907)343-7904 Pump Installation Log Well Drilling Permit Number: SWys P l i 3s 3 Date of Issue: Parcel Identification Number: Legal Description Property Owner Name & Address: fit? Ke y + C_t_, /4Q,1Z4-�5 C F�c1G i3, /f i `i S_4 7 Pump Installation Date: I Pump Intake Depth Below Top of Well Casing: ,C/0' feet IPump Manufacturer's Name: wrs;�s n 0 Pump Model: /(_NAc r c> Pump Size /l4 hp 3 go Rt - i Pitless Adapter Burial Depth: ,&** feet I Pitless Adapter Manufacturer's Name: EJf,2.$r,Lr Pitless Adapter Installer: M t ck.ct C-1 GoW't, r Well Disinfected Upon Completion? 0 Yes ❑ No Method of Disinfection: Comments: IPump Installer Name: Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump installation. Municipality of Anchorage Community Development Department On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99599-6650 • http://www.muni.org/onsite • (907) 343-7904 Subdivision ; rA V_, �i� Well Decommissioning Block Lot T R Section Lot On-site Water & Wastewater Program certified contractor performing the well decommissioning: Name: G Company1 ori Well decommissioning date! r ti Signature: Method of decommissioning: AMC 15.55.060L1 a. ❑ b. ❑ C.A Location: Use the space below to provide a drawing of the property showing the following items; • North arrow • Decommissioned well, • Other water wells on the property, • Two separate swing -tie distances for each well shown on the drawing, !Vote: The swing -tie distances shall be measured from either permanent structures or the property comers. Development Development ServicesiBullding SafetylOn Site Water and WastewatenForms\Client Forms\Well .doe On -Site Water & Wastewater System Permit MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water & Wastewater Program 4700 Elmore Road, PO Box 196650 Anchorage, AK 99519-6650 Telephone: (907) 343-7904 Permit Number: OSP151353 Tax Code Number: 05112219000 Work Type: WellSeptic Upgrade Permit Effective Dates: November 05, 2015 to November 04, 2016 Design Engineer: NORTH RIM ENGINEERING Subdivision: LAKE HILL ACRES #5 Site Legal Address: LAKE HILL ACRES #5 BLK 1 LT 2 G:1562 Owner/Address: BOWERS MICHAEL J & LAURA L PO BOX 671255 CHUGIAKAK 995671255 Site Mailing Address: 22339 MIRROR LAKE DR, Chugiak Lot Size in Sq Ft: 34991 Total Bedrooms: 3 This permit is for the construction of: Y Disposal Field Y Septic Tank N Holding Tank N Privy Y Private Well N Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80). 3. The wastewater code requires inspections during the installation. The engineer must notify the Development Services Department at least 2 hours prior to each inspection. Provide notification by calling (907) 343-7904 (24 hours). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must either: A. Open and Close on the same day. B. Covered, sealed, and heated to prevent freezing. Receivec Issued B MUNICIPALITY OF Community Development Department Development Services Division On -Site Water & Wastewater Program Phone: 907-343-7904 Fax: 907-343-7997 ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. QQ- /22 -/ `t Property owner(s) M/lC F 0,9S12S Day phone Mailing address2233 9 j;,jr 0e,3A LK. 46 Alt Site address if Legal description (Sub'd., Block &Lot) 1/4Z 4C,eoeX Legal description (Township, Range & Section) Lot Size -34(, q/ Sq. Ft. Number of Bedrooms __3___(be'rp+ a -eo rtl APPLICATION IS FOR: APPLICATION IS AN: - TYPE OF DWELLING: (® all that apply) Absorption Field Initial ❑ Single Family (SF) Septic Tank Upgrade. (w/wo ADU) Holding Tank ❑ Renewal ❑ Duplex (D). ❑ Privy F-1 Multiple Dwellings ❑ (SF and/or D) Private Well Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. owner or authbrized agent) Permit/Rush Fees: Jig f;S ??,/ Date of Payment: 16 hobtr Receipt Number: C -b 35'1 Permit No. 0506053 353 Permit App_9-1-12.doc Waiver Fees: Date of Payment: Receipt Number: Waiver No. TP 12 M ENGINEERING MEMO Steve Eng, PE, PH PO Box 770724, Eagle River AK 99577 (907)694-7028 SteveEngPE@gmail.com Date: 10/20/15 Number of Pages: 6 To: MOA On -Site Services Subject: Lakehill Acres 5th Addition, Block 1 Lot 2 Septic System Upgrade The subject property has been served by a holding tank for a number of years. The holding tank is to be decommissioned and a new STEP/mound system installed. The design calls for a new 5' wide trench with new STEP tank: the system will be oversized to a 4 -bedroom design. The entire subdivision is on private wells and septic systems. The terrain slope is low relief. The existing water well will be decommissioned and a new water well drilled. The mound site is a clean sand fill that has been in place for a number of years. bdM2/. Please review the wastewater system design for the existing tjr. I have included design plans & specs, design guidelines, & soil tests. If there is need for additional information or clarification please give me a call. Thanks -Steve ENGINEERING Acres 5`h Addition, Block 1 Lot 2 Wastewater System Sizing: This is an existing 3 -bedroom, single family home. A holding tank is currently in use- this will be decommissioned per UPC and new STEP tank w/ mound system installed. The existing well will be decommissioned and a new well drilled per drawing location. Neighbor lots are served by septic systems and private wells; there are no conflicts. The topography is gentle gradient. The site of the new soil absorption system is a clean sand mound that has been in place a number of years. Recent soil tests revealed clean sand. An application rate of 1.2 GPD/FTZ will be used for the parallel trenches. Length = 500 FT2/5 x 0.87 = 87' trench, 2 trenches @ 43.5'. Specification Requirements: All components and work must comply with the Municipality of Anchorage Specifications (AMC) & State of Alaska Drinking Water Regulations and Wastewater Regulations. • New 1500 Gallon STEP tank. Anchorage Tank or Equal. • 5' minimum between the tank/lift station and bed. 1.0' minimum to property line from trench. • 3' of cover and insulation is required for force main; 2" Minimum thickness for insulation. • Tank & solid pipe must be set on well compacted, stable soil. • 4 inch diameter cleanouts with airtight caps are required F to 4' from foundation wall, prior to any 90 degree bend in 4 inch line. • All cleanouts must extend to at least ground level. • In solid pipe runs, ASTM D-3034 may be used in lieu of cast iron. • Trench to be placed level, minimum of 4' to groundwater, 6' to bedrock. • Drain rock to be '/2" to 2 '/2" screened. Drain rock to be distributed uniformly. • Force main to be 1.25" Schedule 40 PVC or equal. • Distribution pipe to be 1.25" Schedule 40 PVC w/ 1/8" orifice @ 18" on -center. Perforated pipe to be installed level with perforations down. Silt barrier (filter fabric) to be installed above the drain rock. • Smeared bed must be raked or scarified before drain rock placement. • The friish grade must be mounded to promote drainage away from trench. • Insulation must be placed over any pipe installed under driveways or parking areas. • Approved pipe materials include cast iron, PVC ASTM D3034, PVC ASTM F789, ABS ASTM D2661, • Sewer Service Line is minimum 2% slope. • Septic Tank to be pumped every two years or when required. • Insulation board to be extruded direct burial polystyrene (Dow Styrofoam HI/equal) Mirror Lake Designated Wetlands New Leachfield w/ 1,25" Schedule 40 PVC Pressure Distribution Ne Well not Welk 10(.0 ° ecom isslon Old wetlands u Holding Tank Per UPC ew 1500 Gallon TEP Tank 1% Slope Neighbor 1% Slope $eptic 3 Bdrm fco 1% Slope 1% Slope Existing Mounded Sand 7 0 Hl 1% Sl0 ase ent — 10' Utl'ity eCC r) scion fJld o% Water Well mq, CA Mirror Lake Drive •P�E.OF Z,4h LAKEHILL ACRES 5TH NOR THRIM : ENGINEERING ADD. BLOCK 1 LOT 2 PO Box 7 Engle River, Absko799577/3y SS.± i'� WASTEWATER DESIGN 907.694.7028 STEP/MOUND 1" = 40' PLAN LAYOUT it 10/30/15 12, of 3 N i-' 0eLa da N d L Lf) Y L d C5 C: L� 4' 3 O C, C5 a, U L O C5 d a 3 0 O C d L V", N W 4 H a N ai UQ fD- Ltn N 54L UN \ 0 N 3 4 N3 nU 1 W N L N Ifl U I 0 Ta C5 CO � 3 3 > > @1 O L N l7 U L U L a U a a a, L 3 4i a O O U 4' U d > O d i d 3 3 L U (� U L= -O) LO .6 Q d CD i O 75 a O + x a, U O > W 3 d } 71 IL Vim 0 N -P S L CU a U N a u N O 3 L7 UI £ 0O£ 3----'. LO W c d Ln N a Em f �; O U 3 CU 0- O U 0 pa L p)S UI754" a, 0 £ a, LO 0-4, L 0 UL7 LJ p O C) L) N a,°� W UU V � a dU LO O S- Ql4 H N C U N N f O p N Z S U i 0 L i O 3 w 4 Oj3 da+, v 3 NC5 v 00,300 Lp L N p0 , W Fa .; N M 14- Ln 0 I, 00 a N S❑I ENGTH IUM INEERING LOG - PERC❑LATI❑N TEST Performed For: Mike Bowers Date Performed; 8/7/15 Legal Description: Lakehill Acres 5th Addition Block 1 Lot 2 1 - 2 - 3 - 4 - 5 - 6 - 7 - e- 9 - 10 - 11 - 12 - 13 - 14 - 15 - 16 - 17 - 18 - 19 - 20 - 21 - DEPTH (FEET) Organic SP Sand Fill SP Sand w/ Gravel Low Silt Seep TR Location; See Attached Design Groundwater? Yes Depth -- Water Depth After Monitorino.6' Dnte; 10/19/15 # Date Gross Time Net Time Depth Net Drop 1 8/7 0 -- 7" -- 2 8/7 10 10 min. 10.5" 3.5" 3 8/7 12 -- 7- -- 4 8/7 22 10 min. 10.5" 3,5" 5 8/7 25 -- 7• -- 6 8/7 35 10 min. 10.5" 3.5" 7 8/7 37 -- 7" -- 8 8/7 47 10 min, 10.5" 3,5" 9 8/7 50 -- 7' -- 10 8/7 60 10 min. 10.5" 3,5" Percolation Rate 3 min,/inch Perc Hole Diameter 6" Test Run Between 4' and 5' Comments: Prp�nakpd MPnsurPd to nPnrPq1/1f h inch Performed By NnrthRim Eng, I ���' CERTIFY THAT THIS TEST WAS Performed in Accordance with All State/Municipal Guidelines in Effect ON THIS DATE, DATE: 10/19/15 NOR THRIM ENGINEERING PO Box 770724 Eagle Rlwr, Alaska 99577 907.694.7028 TESTH❑LE LOG GE❑TECHNICAL TH1 _- Ut 9/15 1 of 2 S❑ILS LOG - PERC❑LATI❑N TEST �� TNI I2 M ENGINEERING Performed For: Mike Bowers Date Performed: 8/7/15 Legal Description: Lakehill Acres 5th Addition Block 1 Lot 2 DEPTH (FEET) 1 - Date Gross Time Net Time Depth Net Drop 1 8/7 0 7" 3 - 10 10 min. 10.5" 3.5" 4 - 12 5 - -- 4 8/7 C 10 min. 10.5" 3,5" 5 8/7 25 7 - -- 6 8/7 �r: 8 - : 7 8/7 9 - -- 7' 10 - 8 8/7 11 - 10 min, 10.5" 12 - 9 8/7 13 - -- 7" 14 - 10 8/7 15 - 10 min, 10.5" 16 - 17 - 18 - 19 - 20 - 21 - Comments; Organic SP Sand Fill SP Sand w/ Gravel Low Silt Seep T:H, Location: See Attached Design Groundwater? Yes Depth -- Water Depth After Monitorino,6' Date: 10/19/15 # Date Gross Time Net Time Depth Net Drop 1 8/7 0 7" 2 8/7 10 10 min. 10.5" 3.5" 3 8/7 12 -- 7' -- 4 8/7 22 10 min. 10.5" 3,5" 5 8/7 25 -- 7' -- 6 8/7 35 10 min, 10.5" 3.5' 7 8/7 37 -- 7' -- 8 8/7 47 10 min, 10.5" 3,5" 9 8/7 50 -- 7" -- 10 8/7 60 10 min, 10.5" 3.5" Percolation Rate 3 min,/inch Perc Hole Diameter 6' Test Run Between 4' and 5' Performed By NorthRim Fng, I ��� CERTIFY THAT THIS TEST WAS Performed in Accordance with All State/Municipal Guidelines in Effect ON THIS DATE. DATE: 10/19/15 NORTHRIM h�P` ENGINEERING *'asmi PO Box 770724 Eagle River, Alaska 99577 ,¢ 907.694.7028 "f TESTH❑LE LOG GE❑TECHNICAL TH2 10/19/15 12 of 2 -� 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 PHONE El NEW I`, U(— CPUr � Z'7Z -'7 AUPGRADE MAILING ADDRESS ox (o3 - ee a_ ►2, cikob tm� -u LEGAL DESCRIPTION LOCATION n, NO. OF BEDROOMS Well Absorptio- area Q welling _ PERMIT NO. DISTANCE TO: Uy F Z ManufacturerIF Material No. of compartments aQ W F. Liq. capacity in gallons Inside I t Width Liquid depth HOMEMADE: OJ �= DISTANCE TO: Well ( f_ Dwelling PERMIT NO. Z T ©(.y 7 02< Liquid in,.g�II Manufacturer Materiel. §rG�I_ capacity Gbbo O Well Foundati n Nearest lot line PERMIT NO. Lu y DISTANCE TO: J LL Z No. of lines Length of each lineT le of lines Trench width Distance between lines F- Z w inches FTop of tile to finish grade Materi I neath tile Total effective absorption area p inches Length Width Depth PERMIT NO. LU Q h Type of crib Crib diameter d/4 Total effective absorption area wa LU Well Buill6g foundation Nearest lot line DISTANCE TO: J Class Depth Driller Distance to lot line PERMIT NO. w Building foundation er i Septic tank Absorption area(s) DISTANCE TO: OTHER PIPE MATERIALS L �p�/� T VQ SOIL TEST RATING i INSTALLER REMARKS rl I. f'w V-4 r Ha e. 4 r?:. 6 0 n I"oberi A. .zn +ter ; i ee Ljk t, AP 0 E 4�f� LEGALISE 03 1 xQ�DATE TYPE OF SOIL ABSORPTION SYSTEM IS: TRtWeH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 350 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 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). pi.0 F= v___N 11 11 K> F= E-8 _r F=l r-4 K :EF 172 f2 ID 10 ID In f=1 I I ID r -4!E - 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. --- -rWID < 214 > I F=' F=',C:- -T- I C - I" n Fe- F= FEi U I FRECm --- BACKFILLING --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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='F= F;-* M I 7r F=: -e 1=0 I F'E'-=. C- E: 1:: E= M E I=- F? 2:-1 I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: ------- on_ 14 APPLICANT :IL CH ISSUED BY V4. 0 DEPARTMENT' HEALTH AND ENVIRONMENTAL 'OTECTION 825 "L` STREET, ANCHORAGE, AK. 99501 264-4720 l7ir-4—!E3 I -FF=" UF=*r__3F-_*nE--l= F>F=F;?-M I -IF PERMIT NO. c' 820809 ) APPLICANT BILL CATTANACH BOX 63-93 SR2 PIONEERS DR CHUG 272-7567 LOCATION LEGAL L261 5TH ADDN LAKEHILL ACRES LOT SIZE 999999 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM IS: TRtWeH MAXIMUM NUMBER OF BEDROOMS = 3 SOIL RATING (SO FT/BR)= 350 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: 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). pi.0 F= v___N 11 11 K> F= E-8 _r F=l r-4 K :EF 172 f2 ID 10 ID In f=1 I I ID r -4!E - 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. --- -rWID < 214 > I F=' F=',C:- -T- I C - I" n Fe- F= FEi U I FRECm --- BACKFILLING --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. OTHER REQUIREMENTS MAY APPLY. SPECIFICATIONS AND CONSTRUCTION DIAGRAMS ARE AVAILABLE TO INSURE PROPER INSTALLATION. F='F= F;-* M I 7r F=: -e 1=0 I F'E'-=. C- E: 1:: E= M E I=- F? 2:-1 I CERTIFY THAT 1: 1 AM FAMILIAR WITH THE REQUIREMENTS FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNICIPALITY OF ANCHORAGE. 2: 1 WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODES. 3: 1 UNDERSTAND THAT THE ON-SITE SEWER SYSTEM MAY REQUIRE ENLARGEMENT IF THE RESIDENCE IS REMODELED TO INCLUDE MORE THAN 3 BEDROOMS. SIGNED: ------- on_ 14 APPLICANT :IL CH ISSUED BY V4. 0 ELI .0:' Division o, beo,s.g,a, anu� icai surveys .pu..s/ 3001 Porcupine Drive (Te . 277-6615) • Anchorage •.Alaska 99501 a 14 "3`l S ., yr ALAI" DEPARTMENT OF NATURAL RESOURCES • WATER WELL RECORD Drilling Company Name illolssrTwae>t �4r1� Aa U.S.G.S. Local Ila. Drilling Permit No. LOCATION OF WELL Please complete either Ia• lb, or id. A.D.L. No. Ia. Bo?cuggh Subdivision LL _t Rl Deft ib. FrSctlon Section No. Township Range meridian It. Distance and Direction from Road Intersections 3. OWNER OF WELL: l0 yvcJ(f1l . Address: 7I Street Address and Area of Well Location - . WELL LOG Feet Below Surface Material Type Top Bottom WELL DEPTH: (complete f[ Surface Elevation Date of Completion ►i. I T tt aOve r bitt- n A 5. Cable tool. Rotary Driven []Dug Jetted ❑ Bored ❑ Other:__ ^ 4_0❑ 6. USE: •[30bmastic C]Publ is Supply ❑ industry irrigation ❑Recharge ❑Commercial E]Tes[ Well Other: 7, CASING: O Threaded Lj Welded in. to ft. Depth Weight lbs/ft. in. to ft. Depth 8. FINISH OF WELL: Type: o 4Ae- Diameter: G" Slot/Mesh Size: Length: Set between ft. and ft. Fittings: 9, STATIC WATER LEVEL: �_ ft. ElAbove M Below land surface Type of Measurement: 10. PUMPING LEVEL below land surface ft, after hrs:- pumping 9 -P.m. ft. after hrs. pumping 9•0•n'• I 11. WELL HEAD COMPLETION: El In Approved Pit ❑ Pitless Adapter inches above grade 1 I 12. GROUTING: Well Grouted: El Yes ElNo Material: ❑ Neat Cement ❑ Other: 13. PUMP: (if available) HP Length of Drop Pipe 0 ft. capacity 9•P• Type: ❑ Submersible []Reciprocating ❑ Jet ❑ Other: 14. REMARKS: at 50 orm punnP r.A 01, 30 .. 1.7 Lr,` �,`ii_ ,-1 Wi11:c�;1' 5 i;� i[iiiEEt-i: l; ',0011825?6 ;t;wi:riz, ii:[iii1IES _fflt-i!: Ti IC,U — filj .1:+_f:! E I - '4! (. i�lJ a til' 141 +01''`>N FMt!t: 0011) M j_,r.";' �!">•.' i._C)i:,l L1 Gi6 lJ IIL.T NI�ThI E' 11 i •r °� :,� i ';� rrj.� F1 h:.L i_LL-.k 1`"r�!. 1`.ti t, ,'1 i�1 C-l'i`t l-' :ri _:, Fr. r. `, ,>,�; 1, r is r I. I;Et li(l:ii AJ_I:�T 1_i c;,14: .., rLE L1,1E I_1_.II.... is li` if:::l l Signed: - Date, ... , c i 4 Fort 02-ww? .._ry .. -, _ .,1ITr _ a DGf S. 0141 Dril:er. ;AIIARv - Custo"r MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES M T 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 I.D.# .4751 - 1n_�Z- \q HAA# 01a/h,I-El23 1. GENERAL INFORMATION Complete legal description Lot 2; Btock 1; Lake Hitt AcAes #5 Location (site address or directions) 99339 M,ihnair Lake. Dk.i vo. H Property owner M.i.chae,2 9 Lama Bowens Day phone 688-4494 WfZi 243 5Z5 Mailing address HC 79:`," Box -6385 Chagiak, AP ,ska 99567 Lending ade-ncy CityMoictaage Day phone Mailing address Anchorage 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 XXJ Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to ttest- ing_to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: _Individual on-site _. Holding tank' XX 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 #21 W Vow X089 46A 'Aad) SZPZL •>laonA s,aaauibua leuolssaloid aql ul suolsslwo ao sao.ua ao; alglsuodsai lou sl a6eaogouV to AjlledioiunW agl •ponssi si a>eoppeo a aaoleq elep azAleue ao suolloadsul lonpuoo lou op SHHO;o saaAoldw3 -sluaweiinbei alels pue leaapai ulelaao Alslles oliepio ui suollnlllsul 6ulpual Magi pue sawoq to saasegoand of Aselinoo a se slgl saop SHHa aql •eilselV to elelS aql ul paaalsibaa aaaulbue leuolsseloid luapuedapui ue Aq anoge g gdeibeied ul uan16 suoileluasaidaa eql uodn Aluo paseq soleoilpliaC) lenoaddV /4ljoglnV glleaH sonss! (SHHa) 9901AJ96 uewnH pue glleaH to luawliedaa a6eaogouy to Allledloiunlnl eql sled :suollelndlls 6uimollol ay; ql!M 'swooapaq IF sluawwo0 leuolllppt/,`' , \ 1 a01 leno.idde Ieuolllpuo0 _. _. 'panoaddesla - •swooapaq a01 panoaddy X 3aflltlNMS SHHa 9 alet] aanleu6ls s,a90ul6u3 ssaa ppy PO4 VIR peon dool .aaAla BI5e3 KOL L auogd VNIN33NIVINIR 5 1 S wall }o aweN •uolloadsui slgl to alep aql uo loalla ul suollelnbei pue 'saoueulpao 'sapoo alelS pue ledlolunn Ile gl!M eouelldwoo ul s wa}sAs lesodsip aalennalsem ao/pue Alddns aajBm al!s-uo agl'uolloedsui pue u01le61ls9nu1 AW woal pue sal!d 96ea0gouy;o Al!led!o!unW aql woaj paulelgo uollewaolul aql uo poseq legl A}!aanaaglanj I ulaaaq poleolpul ainlowls }o adAl pue swooapaq to aagwnu aql aol alenbape pue leuolloun}'a;es s! walsAs Iesodslp aalennalsem ao/pue Alddns jejuni ails-uo eql legl smogs uolleolldde Ienoaddy Allaoglny gllealH slgl }o u0lle61ls9nul AW legl Allaan l 'molaq umogs alep uo!leP!len aql to se pue olaaag paxldle leas Aw Aq pallllaao sy d33NION3 A8 N01103dSNI d0 1N3W3.L`d1S 'S Municipality of Anchorage Department of Health & Human Services _ { HEALTH AUTHORITY` APPROVAL CHECKLIST Legal Description: Parcel I.D. A. WELL DATA Well type If A, B, or C, attach ADEC letter. ADEC water system number Log presentON) \/ Date completed ll- \4-43t Driller M P�tatilUSa Total depth 40, Cased to 40' Casing height j 2 �>- Sanitary seal 6YN) Wires properly protected &N) Date of test Static water level Well flow Pump level FROM WELL LOG 11-1�t -gl tr SEPARATION DISTANCES FROM WELL TO: AT INSPECTION -9,0UNICIPAUTY OF ANCHORAGE ENVIRO MENTAL SERVICES DIVISION S �tiN 1992 3. L g.p.m. ��- RECEIVED Septic/holding tank on lot k od , ; On adjacent lots I loo t Absorption field on lot �� ; On adjacent lots t ua Public sewer main Public sewer manhole/cleanout ti I)�" Ia- Sewer service line 25 Petroleum tank 2S i+ WATER SAMPLE RESULTS: Coliform 0 Cyt! Ivo �"ONitrate y 2 �� Other bacteria tl-b �f�z_ Date of sample: Lo Collected by: S & S ENGINEERING 17034 Eagle River Loop Road No. 204 B. SSPWW/HOLDING TANK DATA Eagle River, Alaska 99577 Date installed $ By Tank size env Compartments Cleanouts.O/N) Foundation cleanout(3/N) Depression (YA ►-! High water alarm &N) Alarm tested &N) Date of pumping (D -• -40 - 92 Pumper s . (SSS Coo L. SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot ' 10D r On adjacent lots 11f �b , Foundation 10 t .V- To property line 4 Absorption field �1�' Water main/service line t a Je- Surface water/drainage tob'� 72-026 (Rev. list) Front - _ - - CONTINUED ON BACK PAGE C. LIFT STATION Date installed Size in gallons Vent(Y/N) High water alarm level — Meets MOA electrical cod SEPARAJ Well own lot "Pump on" level at Manufacturer Manhole/Access (Y/N) " p off" level at Cycles tested STANCE FROM LIFT STATION TO: On adjacent lots D. ABSORPTION FIELD DATA Date installed Length Width Total absorption area Depression over field (Y/N) Results (pass/fail) Peroxide treatment (past 12 months) (Y/N) Surface water Soil rating System type —Gravel thickness Total depth Cleanouts present(Y/N) Date of adequacy te§ for If yes, give date SEPARATION DISTANCE FROM ABSORPTFI�O: Well on lot n adjacent lots Property line To building foundation To existing or abandoned system on lot On adjacent lot Cutbank Water main/service line Surface ater Driveway, parking/vehicle storage area Curtain drain bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. S & S ENGINEERING 17034 Eagle River Loop Road No. 201 Signature Engle Rivet, Alaska 99571 Engineer's Name Date HAA Fee $ Z o/ Waiver Fee: $ Date of Payment 2v _ Date of Payment Receipt Number 3 Receipt Number Time APPLIC NT FILLS OUT UPPER HALE ONLY Property Owner �� ' !` �.j i'- rl;trr;}t �(. {-:-/.+lei-<(' �� ]Phone Date Date Zip Code Date Mailing Address Inspector Inspector Buyer" Inspector Address Zip Code Lending Institution -,, - ('- � '`t r ; Phone Address ;. ;_ Zip Code Realty Co. & Agent ,- y t , l i ,. •�_ ,,.,. t_ Yl�- - L- l t, L ,�--)i.-:'• t 'i Phone ENVIRONM-NTAL +.`dr 11 / `j ti Zip Code -t�.. ��.`y' Address — �� ,! Legal Description i✓ -:r t� ` -� i-;-� i !) `i �ti j�`t,-`��:�- (�yy APPROVED BEDROOMS 'CONDITIONS OF APPROVAL DISAPPROVED /( Street Location ���2'�',F. i''YE. -��� ;(�L` i'1(�tf(-_ )Ztt_ �. Type of Residence - BY: GYSingle Family Soils Rating Date Sewer Installed ❑ Multiple Family No. of Bedrooms Septic Tank Size ❑ Other Well to Tank Water Supply individual -• ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available). ❑ Public Utility Sewer Disposal - O Individual Year Individual Installed: f ❑ Public Utility When Connected to Public Utility: ❑Molding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time - Time ` U Date Date Date Date _, I C)'— Inspector Inspector Inspector Inspector - n" Field Notes: MUNICIPALITY OF ANCHORAGE �t�yp DEPT. OF H=i'. Ti I I PROTECTION ENVIRONM-NTAL "C) EIVED (�yy APPROVED BEDROOMS 'CONDITIONS OF APPROVAL DISAPPROVED /( ) CONDITIONAL APPR/OVAL' C �a t DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank Time APPLIC AT FILLS OUT UPPER HAL -`,ONLY Property Owner I . k `' � is vim.. l— � �"+-1 A - 'v Phone 7 Mailing Address Zip Code Date Date Buyer C ' 1:_c; `\ �..�: ,..- 4:_. c �� Inspector Address Zip Code Lending InstitutionC' r, ,v� �_ �_.� c�lo� 1 li- Phone ; Address ( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL Zip Code Realty Co. & Agent Phone Address Zip Code Legal Description Z- 1 tD k LGt L/e 1� 1 j �� Y- " S 14 C7 Street Location �VA i �y a o*- Lc • Y Soils Rating Date Sewer Installed Type of Residence Well Log Received U,SMgle Family Septic Tank Size ❑ Multiple Family No. of Bedrooms ❑ Other Water Supply 1e1. dividual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. ❑ Community For wells drilled prior to that date, give well depth (attach log if available), ❑ Public Utility Sewer Disposal(' a ❑ Individual Year Individual Installed: ( C' ❑ Public Utility When Connected to Public Utility: Q-Ko-lding Tank ."e NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time U Date Date Date Date Inspector Inspector Inspector Inspector n Field Notes: ( APPROVED BEDROOMS 'CONDITIONS OF APPROVAL ( ) DISAPPROVED ( ) CONDITIONAL APPROVAL' f 20 ^ �� DATE BY: Soils Rating Date Sewer Installed Well To Absorption Area Well Log Received Septic Tank Size Well to Tank Pin'L�LQ GREATER ANCHORAGE AREA BOROUGH Department of Environmental Quality 3330 "C" Street, Anchorage, Alaska 99503 274-4561 L -A3 IGI be- Date Received C)r�i >_ I9 y(l r)d. Time of Inspection Date of Inspection REQUEST FOR APPROVAL OF INDIVIDUAL SEWER & WATER FACILITIES FOR 1. Approval requested by: n 1 �1c Mailing Address: (�+P �p���� �,10� ��s_ ��a�� Phone: - 2. Property Owner: Phone: 3. 4. Mailing Address: Legal Description: Location: �i,>nc>�- 9,4 2t -)CAL I 20 - `2o n I�hnCF a�i A >f 5. Type of facility to be inspected, No. of bedrooms 6. Well Data: A. Type (� B. Depth C. Construction D. Bacterial Analysis 7. Sewage Disposal System: A. Installed B. Installer C. Septic Tank: 1. Size 2. Manufacturer D. Seepage Pit: 1. Absorption Area 2. Material E. Disposal Field: Total length of lines 8. Distances: A. Well to: Septic tank , Absorption area Sewer Lines , Nearest lot line Other contamination B. Foundation to septic tank , Absorption area C. Absorption area to nearest lot line EQ -034 (1/74) Paae 1 of two Daaes 1. Type of Inspection 2. 3. 9 �= ��`. MUNICIPALITY OF ANCHORAGECa c 1 DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 "C• Street, Anchorage, Alaska 99503 — 274-4561 REQUEST FOR APPROVAL OF INDIVIDUAL SEWER and WATER FACILITIES Property Owner: uaey Mailing Address: Name of Buyer: Mailing Address: Name of Lending Institution: Mailing Address: CMRO VA FHA Day Phone Day Phone Phone CONV 5. Name of Realtor or Agent: ey e— /h Mailing Address:1 (LLj 19� T Ar,4.5) ad@Phone 219— n�9 6. Legal Description: Y Ra 1 Location: 'o _— n 7. Type of Facility to be inspected: S. ,^ o�� J" No. Bdrms. 2, 8. Water Supply Type of Supply: Public Utility Individual If Individual, number of dwellings presently served If Individual, depth of well 9. Sewage Disposal System Type of System: Public Utility Individual (on-site) If Individual, date of installation EQ -037 (1/74) Page 2 of two pages - Rei st for Approval of Individual !r & Water Facilities Legal Description t rnr A 1 rLf?- 61 L's. ( A r n o zo GA'Ac'% Comments Approved Disapproved _ZZ 92',04- 9,l Date �� zy / 5 Approval,Valid for one year from date signed Greater Anchorage Area Borough, Department of Environmental Quality DIAGRAM OF SYSTEM I certify that the information contained in this request for approval to be a true ana accurate representation of the subject sewer and water facilities and these facilities are operating satisfactorily. SIGNED Date EQ -034 (1/74) 1 I STI MIDL ALITY OF ANCHORAGE POUCH 6-650 ANCHORAGE, ALASKA 99502 No-Vcmber 26, 1975 'Irs. Jackie Dohl Star Realty 640 West 36th Avenue Anchorage, Alaska 99543 SUBJECT: Lot 2, Lake bills Acres Addition #5 Dear Mrs. Dohl: }?e: have made an on-site survey of the subject lot. According to our files it appears that the subject lot may not have soilS suitable for on-site setv;aje disposal. At the time of inspection I lvlas unable to determine if there caws art cxistiiag sc-ijage disposal system on the property. Z'C you are .planning to upgrade or instal d a .new sewage disposal `iysi;Cm YOU mus'", 'i'trS"C 0.^,Lc�Yn a germtt from this office. If you have any questions regarding this ratter please cw71 rye at 27'Ir..45,,q :art. 1 r: YJ• Sincerely, :=rind Beatty Sanitarian `J/sg 0