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HomeMy WebLinkAboutSOUTH HILLS BLK 3 LT 3South Hills Block 3 Lot 3 #017-072-23 Municipality of Anchorage , ' ' '° •, (' Development Services Department Building Safety Division - Ori Water and Wastewater Program, 4700 Bragaw St. P.O. Box 196650 Anchorage, AK 99519-6650 Page 1 of 3 www ci.anchorage.ak.us (907)34}7904 ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Permit Number: SWO90172 PID Number: 017.072.23 N,na ott Selman Wastewater System: ❑New E] Upgrade AdtrnF Own Ln ABSORPTION FIELD Phor» NNMr a BMpNM o Deep Tm«.m p SlMmww irNrn 10 ON! p Mand O am LEGAL DESCRIPTION SW •' TNNopnl�ad GPD/Ftz 3.0 LI. 3.0 BmPdI L« aUCdMNPrm DFdh to Ppa 1xxtm from NmaWY(Fide Gr v depth biwaw, ppe 3 3 South Hills SID 2.5 FI. 0.5 FI Tp Ki Harp Swam F« Wdad Nene W" Vad• Gnaw LNgn 0 FI. 29 FI. Well: New Upgrade c MrnO" 14 Nu CO Ii 3 DNrae OeNw• " 5 FI. FI c4FNhcNm (P V*. A B. C)TNN DWn Caeed b 7NN abecrptwn rw Pop. MNenal EXISTING PRIVATE FI. FI 406 Fel PVC F810 paler DNB DNW SINK Wow L" WVNW DNe kgiW.d FI DEARMOUN EX 12/3011985 YMd Pump sei N Cawq NNpM A G, m p TANK CPM FI. FI SEPARATION DISTANCES ❑ Septic ❑ Holding ® S.T.E.P. ❑ Other. 7o Septic Absorption Lift Holding lubliciPirvale eC"" N ty Fran Tank Field Station Tank Sewer Line ANCHORAGETANK 1000GN Wed 120.7' 102.0' 127.2' 97.4' MNrw STEEL NunoracNrorlNwF 2 s,.fN.WNW 139' 177.4' 141.8' LIFT STATION LN Lna 23.0' 13.0' 25.8' • 250 Gam xl�r Orencol Anch. Tank Fo.r,"w 59.6' 72.9' 69.5' • 'Pu W iw,* V +40 "Pu ixr b w +36 Hqh wlr Nrm N +45 n n Puny M" a M xNi ENNr¢r VAP•NmNn Pedrned by C~ Drrh Orenco P2005 Ed's Electric ° xist'g tank and lift station abandoned per Code. Exi BENCH MARK 1prauarm rod DewmWo Installer. A+ Home Services Dates listed below as date of insp. Nail in tree next to tank .K,, 100.0 FL Engineer's Stamp Inspections performed by: PANNONE ENG. SVC, LLCDates:1' 91312009 ++i 2hd 919109 �•p �..........qC Development Services Department Approval Conditional Approval Date: „„ •,•,,,,;;, ,,; ....................... � �•i t .Steven R. PGnnone.�= ' Lv oZ� ' /,0 No. CE 8149 1� i # +++ ���.... Reviewed and approved by: / Date: J� ��• % V 41 -------- ------ EXISTING--'�, -_ �'/^' EXISTING •'�\ ABSORPTION ' % / 5 WELL \ FIELD Jtil Esmt'• NEW-1�50g S.T.E.P. TANK EXISTING TANK, ABANDONED PER CODE 3.� F-1 L _ _ J J� 102.0 I r 37.3 -� 120.8 i �. 23;0 H EXISTING / 3BR HOUSE W- .0 .r ''• `,----- ----- ----------------------- --- - -- ~<--� NOTES: RECORD DRAWING PLAN 1 -------------- 11 ` rl 'r PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SOUTH HILLS S/D BLK 3 LT 3 Scott Selmon 7640 Our Own Ln. Anchorage, AK 99516 f I SWING TIES CO A B LS FC 6.3 29.2 T1 62.7 70.5 T2 67.7 77.2 LS 69.5 78.7 F1 109.8 47. 3.� F-1 L _ _ J J� 102.0 I r 37.3 -� 120.8 i �. 23;0 H EXISTING / 3BR HOUSE W- .0 .r ''• `,----- ----- ----------------------- --- - -- ~<--� NOTES: RECORD DRAWING PLAN 1 -------------- 11 ` rl 'r PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 SOUTH HILLS S/D BLK 3 LT 3 Scott Selmon 7640 Our Own Ln. Anchorage, AK 99516 f I ;R, Z ------------ SOF Date AGgsl�) 9/10/09 Scale •... . .,NO P.I.D. .�. / 17-072-V .even annorSe % CE 8149 � 9?OfE59� � PERMIT NO. SA1090172 Sheet 1 OF 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: ABANDON EXISTING SEPTIC TANK AND LIFT STATION PER CODE. INSTALL 1250 GAL S.T.E.P. TANK CONNECT TO EXISTING DRAIN FIELD. 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. 6. CONTOURS ARE IN 4 FT INTERVALS. DESIGN PARAMETERS PROPOSED S.T.E.P. TANK NO. BEDROOM: 3 (450 gpd) TANK SIZE: 1,250 gallon STEP CONNECT TO EXISTING FIELD k o DIP DUCTILE IRON PIPE TH 8 FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. 171 11 MONITOR TUBE NO. < wr it III NEW 1250 g S.T.E.P. TANK ABBREVIATIONS Cu COPPER DIP DUCTILE IRON PIPE TH TEST HOLE FC FOUNDATION CLEAN OUT T# TANK CLEAN OUT NO. C# CLEAN OUT NO. MN MONITOR TUBE NO. R.I. RIGID INSULATION DCO DOUBLE CLEAN OUT DV DIVERTER VALVE FS FLOW SPLITTER LEGEND —w—w— WATER LINE/ WELL RADIUS EXIST'G SEPTIC NEW SEPTIC 0 CHAINLINK FENCE NOTES: PC1L\1\Ol\� i:l\G SVC, C� LL.L P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 ���"`\\�� ....�(G� Ak qXk' i%lij�p !y(� *: 49 TMT .... % teven . onnone' j /��'�4 /� f X11 , . Date 9/10/09 RECORD DRAWING scale P.I.O.NO 17-072-2 SOUTH HILLS S/D BLK 3 LT 3 Scott Selman Ln.t7E8141 Anchor ger AK n99516 PERMIT No. SWO90172 DESIGN NOTES sh2eOF 2 09/08/2009 17:00 8686770 APLUS PAGE 01 0.8-M 03:39P fnm'ED's ELECTRIC INC SEPTEMBER 4, 2009 272 4590 T0:8685770 ED'S ELECTRIC INC. P.O. BOX 210767 ANCHORAGE, AK99921 A+ HOME SERVICES ?501 E.140T" AVENUE ANCHORAGE. AK 99516 P.i Fax, {00712724566 TO WHOM IT MAY CONCERN: SUBJECT: 76� pLLIFT R OWN ION, LOT 3 BLOCK 3, SUB D. SOUTH HILLS TO EXISTING UNDERGROUNDWIRINGD NEW TO ALL �NTROL PANEL AND FINAL CODE REQUIREMENTS OFT14ET10N5 NATIONAL ELECTRICAL CODE AND THE MUNICIPALITY OF ANCHORAGE. THANK YOU, -y-� DWAYNE R BRUNS ED'S ELECTRIC, INC. Pannone Engineering Services LLC Steven R. Pannone, Principal Registered Professional Engineer E-mail: steveCaoanenaak.com February 1, 2010 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Re: Response to Comments South Hills S/D B3 L 3 Ladies and Gentlemen: I am writing in response to the comments received on the above referenced project. The responses are addressed in the order they were received. Comment: Make of pump. Response: The make of the lift station pump has been added to the Inspection report. Comment: Final grade over tank. Response: The final grade over the tank has been added to the record drawings. 98.8' Comment: Installer and date of tank installation. Response: The installer and date of the installation were added to the inspection report. 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 102954, Anchorage, AK 99510-2954 Physical: 11301 Olive Lane, Anchorage, AK 99515 Telephone: (907)272-8218 FAX:(907)272-8211 MUNICIPALITY OF ANCHORAGE Development Services Department On -Site Water B 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: Sep 02, 2009 Expiration Date: Sep 02, 2010 Permit Number: SW090172 Parcel ID: 017-072-23 Legal Description: SOUTH HILLS BLK 3 LT 3 Design Engineer: 0062 PANNONE ENGINEERING SERVI( Site Address: 007640 OUR OWN LN Owner Name: Scott Selman Lot Size: 45809 SO. FT. Owner Address: 7640 OUR OWN LANE Total Bedrooms: 3 Permit Bedrooms: 3 ANCHORAGE. AK 99516-3821 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: Aj. Date: Z •0 Dr Date: ^ 0 Municipality of Anchorage • -•1 Development Services Department Building Safety Division i 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 Parcell.D. 017.072.23 Property owner(s) Scoff Selman Day phone Mailing address7640 Our Own Lane Zip Code 99516 Site address 7640 Our Own Lane Zip Code 99516 Legal description (Sub'd., Block & Lot) South Hills SID, Block 3 Lot 3 Legal description (Township, Range & Section) Lot Size 45.809 Sq. Ft. THIS APPLICATION IS FOR (® all that apply): Absorption Field ❑ Septic Tank Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage ❑ Number of Bedrooms THIS APPLICATION IS AN: Initial ❑ Upgrade Renewal ❑ 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: S3 C Waiver Fees: Date of Payment: 9'.2_ 0 7 Date of Payment: Receipt Number: O G 7 7 3 I Receipt Number: (Rev. 11105) Pannone Engineering Services u.c Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve0panenaak.com September 1, 2009 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: South Hills S/D Block 3 Lot 3 EMERGENCY Septic Tank Replacement Permit Request Ladies and Gentlemen: I am writing to request that a permit to install a new S.T.E.P. tank be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The existing septic system was designed and installed for a three-bedroom house and is operating adequately for three bedrooms. The tank has collapsed and gravel is hindering the operation of the effluent pump. The Owner is pumping weekly to keep sewage off the ground. The surrounding lots are served by private water systems and are over 100 feet from the proposed septic tank. This lot is served by private water and the well is located greater than 100 feet from the proposed system. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. Number of Bedrooms: 3 b. Septic Tank Size: 1,250 gallon S.T.E.P. 2. Surface Water: 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 3 slopes to the west at approximately 1-5 percent based on existing contour information. The proposed installation will be located in the central portion of the lot adjacent to the property line. 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. Perrone LE 6109 , 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 L.o T To w T.S vf-x�rav No top -Le -s /oo .P -r. �¢JPoS�A 1' STe'� TA .v I'MO-M5 AAw-r4 w i oo 4T Frz o.k jNws -zS w c L st ctzEt=lc.. ABANDON E1CeST6; -rAN1c- 4' G/FrS rA"noA--' —F:'Px- C.ort-�e-, NOTES: PANNONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE. AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 ��������\� OFAt.4k „gyp f ( /r�* •' 'IH ..7 % . ... .... ...... tteven •fi. Pannor+ejCE 8749 I�� 14,��// �� Date 41 0 Scale rjOV f}1 Lt' 4z S%p'b UG 3, L T 3 MR. $ce-r S&-C-nAni f1 NGf�CJi1-/�CiP AK 44S/b P.I.D. NO PERMIT N Sheel MUNICIPALITY OF ANCHORAGE DEt TMENT OF HEALTH AND HUMAN SEWY Z Environmental Health Division 825 "L" Street, Anchorage, Alaska 99502, Telephone 264-4720 ✓ ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT Name DISTANCES .Seo7r � Jy�;,S% % �ED!- TO SEPTIC ABSORPTION Address FROM TANK FIELD WELL 113 5 76 -- of IWTo IrX 97_5�0a- ❑ TRENCH BED ❑ W. DRAIN ❑ OTHER - Depth to pipe bottom from original grade 2,-< FT glr Phone(s) Permit No Gravel depth beneath pipe �� s FT No. of Bedrooms WELL51 Gravel width FT Total absorption area - �J SQ FT i✓ A LDSOS�Z Soil rating SS SQ FT -� Installer , ��'/�+M/ ox�S%®%l Date Installed WELLS PRIVATE ❑ OTHER 0dentifVPEPT. OF LEGAL DESCRIPTION LI LOT LINE /4 f- %� ,.-- - Lot Block Subdivision �qRw Ol� �f f 1 1500 FOUNDATION7j ',,j -�-- Township, Range, Section / N jAl SG fi C _ AS -BUILT DIAGRAM (Show location of well, septic system, property lines, foundation, driveway, water bodies, etc.) TANKS ,X SEPTIC ❑ HOLDING Manufacturer I Capacity in gallons Material I No. of Compartments TYPE OF SYSTEM ❑ TRENCH BED ❑ W. DRAIN ❑ OTHER - Depth to pipe bottom from original grade 2,-< FT Total depth from original grade 3 FT / Fill added above original grade —&'_ FT Gravel depth beneath pipe �� s FT �( J Gravel length z 9 FT Gravel width FT Total absorption area - �J SQ FT Distance between lines 5' FT Number of lines Soil rating SS SQ FT Pipe material >ve, 670 Installer , ��'/�+M/ ox�S%®%l Date Installed WELLS PRIVATE ❑ OTHER 0dentifVPEPT. OF F Ei LI Classification (A,B,C) Total Depth FT Cas o ,,,JTJ Q Installer I Date Installed: IREMARKS: ARKS: Cf dot 64,110 ON /NLErIr aNT[ GST x� /��HLJiTis� OW Ael Municipal and State guidelines in effect on this date: Health Department Approval: n �u 72-013 (3/85) 01 Scale: 07/ Inspections Performed by�� Date. 1A 561k certify that this inspection was performed according to all Date: ENGINEER'S SEAL ,`,MUNICIPALITY OF ANCHORAGF"> Departmen� of Health and Environmento__ Protection Pouch 6-650, Anchorage, AK 99502 264-4720 On-site Sewer/Water Permit HANDWRITTEN "T Permit N o: ��� � �. � C��•--�.� Date Issued: YJ Applicant: �"_l_�`% ���\1 (liU _ Address: "t__y� t rpt L1 -Z I 66 - II.Q_ Legal Description: S`/D: j(l 5 Lot: (� Block: Section: R (5- Township: _ ` Range: 3 ��— Lot Size: c4S` 0Z) _7____ (Sq. Ft. or Acres) Lot Location: Max Bedrooms: 3— Listed below are the options available to you in designing your septic system. Choose the option that best fits your site. ----------------------------------------------------------------------------- TRENCH BED W. DRAIN Depth to pipe bottom(ft.) o%{s Gravel depth (ft.) 'S Total depth (ft.) 3 Gravel width (ft.) [LI t Gravel length (ft.) Tank size (gal.) [00 Soil rating (sq. ft./br) ** Gravel length 75 feet requires multiple runs (not e eeding 75 feet each) ** Tank must have at least two compartments '-'e --------------------------------------------------------------------------------- I certify that: 1. I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage(MOA) and the State of Alaska. 2. I will install the system in accordance with all MOA codes and regulations, and in compliance with the design criteria of this permit. 3. I will adhere to all MOA and State of Alaska requirements for the set back distances from any existing well, wastewater disposal system or public sewerage system on this or any adjacent or nearby lot. 4. I understand that this permit is valid for the maximum number of bedroom= stated above, and any enlargement or modification will require an additional permit. IF A LIFT STATION IS INSTALLED IN AN AREA COVERED BY MOA BUILDING CODES, THEN (1) AN ELECTRICAL PERMIT AND INSPECTION MUST BE OBTAINED; (2) AS-BUILTS WILL NOT BE APPROVED WITHOUT AN ELECTRICAL INSPECTION REPORT; AND (3) THE ELECTRICAL WORK MUST BE DONE BY A LICENSED ELECTRICIAN. SIGNED: v`—� — DATE: C Applicant ISSUED BY: DATE: sM ✓ SWP/024 rev.1/85 SOIL TYPE DEP Py U+cS HL ✓ oro �S.�u Z'$1 tiS�s �t 3.V! -9.a' �0 5 T Ao S / So-„c(y hgtne.-atA4 c-_-)Wcs Q, - Groundwater Encountered ? " El Z, VGEOA0, �� SOILS LOG Depth 17,0' � J� 1 131 E." 76th Ave. PERCOLATION TEST Z.•Jr Z. Anchorage, A18Ske 99518 TEST HOLE NO -1 4907? 344-8042 DATE ``3I/2 f8S Job No. BSo'6S PERFORMED FOR:�`���°" __ No. of Bedrooms �or.0 ri//S Z,4 Z b' T /2/c/ �' 3'r+J LEGAL DESCRIPTION TH DESCRIPTION SLOPE SITE PLAN SOIL TYPE DEP Py U+cS HL ✓ oro �S.�u Z'$1 tiS�s �t 3.V! -9.a' �0 5 T Ao S / So-„c(y hgtne.-atA4 c-_-)Wcs Q, - *e •• �- - THOMAS R. SVATrl �Q 2248-E O® e® •••.......• �QIffl 4F • COMMENTS Date Groundwater Encountered ? " Date Z, 811 Depth 17,0' � J� *e •• �- - THOMAS R. SVATrl �Q 2248-E O® e® •••.......• �QIffl 4F • COMMENTS Date Time ` Net Time Reading Depth of Water' Net - Orop / Z.•Jr Z. Z- GAAB-HD-I r G,"TER ANCHORAGE AREA BOROLIAM HEALTH DEPARTMENT 327 EAGLE ST. ANCHORAGE, ALASKA 99501 279-2511 F INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM r MAILING NAME -H, 1's�1d I �,y ������� ADDRESS LOCATION S (� LEGAL DESCRIPTION SEPTIC TANK: DISTANCE FROM WELL /O ATERIAIL C F _mvv� q, 6 ",95�9 7ZA.). KS LIQUID CAPACITY A®®Q .GALLONS. INSIDE LENGTH SEEPAGE SYSTEM: SEEPAGE PIT: .3a3- 401 PHONE NUMBER OF COMPARTMENTS INSIDE WI LIQUID DEPTH- NUMBER EPTH_ NUMBER OF PITS OUTSIDE DIAMETER OR WIDTH , LENGTH , DEPTH , LINING MATERIAL . DISTANCE FROM WELL BUILDING FOUNDATION NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) SQ. FT. TILE DRAIN FIELD: 7` TOTAL LENGTH / DISTANCE FROM WELL FOUNDATION NEAREST LOT LINE OF LINES, NUMBER OF LINES �57 DISTANCE BETWEEN LINES lcf7 TRENCH WIDTH 36 IN. TOTAL EFFECTIVE ABSORPTION AREA 3077 SQ. FT. LENGTH OF EACH LINE 'S',4oa.1-) DEPTH: TOP OF TILE TO FINISH GRADE DEPTHELpO�F FILTER MATERIAL BENEATH TILE. � N. ABOVE TILE WL: A/07-PeILL2'D LpT' See A/A AICE FROM WATER TYPE , DEPTH , BUILDING FOUNDATION. SAMPLE. NEAREST NEAREST SEPTIC SEEPAGE • OTHER LOT LINE f SEWER LINE TANK , SYSTEM CESSPOOL , SOURCES_ DIAGRAM OF SYSTEM DISTANCES: DATE J APPROVED HEALTH AUTHORITY Gly. TMiD-2 GREATL' .,c ANCHORAGE AREA JROUGH Case No. HEALTH DEPARTMENT 327 Eagle St. Anchorage; Alaska 99501 279-2511 SEWAGE DISPOSAL SYSTEM - APPLICATION & PERMIT NAME OF APPLICANT /Gl �+ �°Qn �� �) Zje_ A,SD4,MAILING ADDRESS PHONE NO It RESIDENCE ADDRESS LOCATION OF INSTALLATION - LEGAL DESCRIPTION— APPLICATION ESCRIPTION APPLICATION TO INSTALL: SEPTIC TANK , SEEPAGE PITy , DRAIN FIELD , 0 HE , TO SERVE THE FOLLOWING FACILITY �-C 8 rna FINANCED THROUGH. —TO BE INSTALLED BY TOAN!t# Ga-� TEST RESULTS C_ J M i� /06A ANTICIPATED DATE OF COMPLETION �A� �PERCOLATION BELOW TO BE FILLED OUT BY HEALTH DEPARTMENTO �t,, LOCATION OF WELL (Please complete either to, Ib or le.) lo. Borough Subbd4Aon Lot Block Ib. 1/4gtrs. �b 3 _of_of—of _ HjlIc� DISTANCE AND DIRECTIO FROM R ADN R9 TI S 0,1 A. fur �„ St,eet Address and Area of Well Location 2. WELL LOG Maeriol Type ENVIRONMENTAL WATER WELL RECORD STATE OF ALASKA DEPARTMENT OF NATURAL RESOURES Division of Geological & Geophysical Surveys Drilling Permit No. A.D.L. No. Section No. Township NEI Range E❑ Meridian S❑ W❑ 3. OWNER OFF WELL' 7Address: Feet Below Surface 4. WELL DEPTH: (final) f f. 5. DATE OF COMPLETIOfI - LL�, ��.. Top. Bottom .f a. ❑ Cable tool ,.Q Rotary [3Driven ❑Dug El Auger ❑ Jetted ❑ Bored ❑ Other: 7. USE: M Domestic ❑ Public Supply ❑ Industry ❑ Irrigation ❑ Recharge ❑ Commerical ❑ Test Well ❑ Other: r'L� a. CA ING+ ❑ Threaded- -,A Welded diam. in. tof2-1t. Depth Weight lbs./ft. diam, in. to ft. Depth Stickup '��..--- ft. 9. FINISH OF WELL: Type: 1'. "'fix Diameter: Slot/MAh Size: Length: Set between ft. and ft. Backfilling Gravel pack _ Ang 10. STAAZTIIC WATER LEVEL: /0 ft. Li 1,-, y� Above or ❑ BelowloJg�dd.. ss�urface�� 11 Dote /` Equipment used: 'hrLy'f"8.6s /, //) ION Ii. pUMPING LEVEL below land surface and YIELD l s_ft. after �hrs• pumpingZ.5 9 -P.M. ft. offer hrs. pumping g.p.m. 12.GROUTING Well Grouted: YesEx No Material: (] Neat Cement Other: 13, PUMP: (if available) HP Length of Drop Pipe 1t, capacity g. P.M. ❑ Suhm. F] Jet Centrifical Other 14. REMARKS: I 16. WATER WELL CONTRACTORS CERTIFICATION: 15. Water Temperature ° /1 This II/teas del IIeC u d� 4 my'u sdlclio gywd Ih, report is true to the De t of my kn�o/w ledge and belief; Regi ;ed BusiName Nam (. / Conlracl. ice r)se Numbg/r / 19ne u Date: Authorized Repr�entative Form 02-WWR (11/81) _ _ Copy Distribution: WHITE -State OGGS, PINK -Driller, CANARY -Customer 0 0 MUNICIPALITY OF ANCHORAGE 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 %� �} Application Date x / GENERAL INFORMATION (MUST BE COMPLETED PRIOR TO SUBMITTAL) (a) Legal Description (injcllu{die lot, block, subdivviiissii�on, section, township, range) p f f /� Location (address or directions) 7&1/0 D r.tt_ O a vi kEu (b) Property Owner SAH �y"i" Telephone: Home Business Mailing Address 7611 LD Ou✓' 6U"4 L u (c) Lending Institution-Telephone ✓6+L'SAYI Mailing Address i7 (d) Real Estate Company and Agent N kf e Address Telephone (e) Mail the HAA to the following address: or: Check here if hold for pick up. List contact person and day phone number below. 7 a7 3g�i 2. TYPE OF RESIDENCE Single -Family ❑ 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 0. 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 (Rev 8/86) Front 1�eg (98,8 Ade) eao-zL Z jo Z 96ed i{aoM s,aaau!6ue leuo!ssaload 94j u! suo!ss!wo Ao saoAA@ aol alq!suodsai jou si 96eao4ouy to A4!led!o!unW a41 pansst si ajeo!I!jaao a wolaq elep azAleue ao suo!loadsui jonpuoo jou op SHHO jo saaAoldw3 sjuawaa!nbei ajejs pue leaapal u!ejaao Alsi4es of Aapio ui suo!lnj!jsui bu!pual a!a4j pue sawo4lo siase4oind of Asaunoo a se s!41 saop SHHa a41 eMsely jo ajejS 844 u! paaajs!6aa aaeu!6ue leuo!ssajoad juapuedapu! ue Aq anoge g ydoibeied u! UGA16 suo!jeluasaadaa a4j uodn Aluo paseq sajeoilpiao lenojddy Al!joglny 4lleaH sanss! (SHHo) saO!AaaS uewnH Pue 411eaH to juawjjeda(] a6eao4ouy jo (j!led!o!unW a41 NOI1f1VO Jenoaddy leuo!1!puo(] jo swaal leuo!j!puoo panoiddes!a panoaddy alea --, ` Aq swoapagM7,yv " sol panoaddy / 1VAOHddV SHHO 9 f leas s,aaau!6u3 C;ZZ •o!Yr. — a. J ale(] � ssaappy 9 % _ auo4dalal J — wa!3 jo aweN 'uo!joadsui s!41 jo ajep a4l uo joajja ui suo!leln6ei pue'seoueu!pio'sepoo ojejS pue led!o!uniN Ile 43!M eoue!ldwoo ui s! wajs (s lesods!p aalemalseM ao/pue Rlddns jaleM al!s-uo a4j 'uo!loodsui pue uo!le6!jsanu1 AW woaj pue sal!I 96eao4ouy jo ApludiopnVy a4l wojj pau!ejgo uo!lewjolui a4l uo paseq jegj ApJaA aa4janj I v!aja4 poleo!pui ainjonils jo ad (j pue swoojpaq jo jagwnu a41 aol alenbape pue leuo!jounj'ajes s! wags (s lesods!p aalumalseM ao/pue Alddns aajeM aps-uo a4j je4j smo4s lenoiddy tluo4lny 41leaH s!41 jo u011e611s9nu! Aw 1e4j (juaA I 'Moleq uMo4s ajep uo!jep!leA a4j to se pue 019M4 pox!lle leas Aw Aq patpliao sy NOIIVWHOdNI CNV V1V0 `HOHV3S 3114 `S1S31 `SNO1103dSNl ONIOIAOIId WHId ONIH33NION3 4 LAB INSTRUCTIONS Report Printed. MAY 12 87 8 09:22 WORKORDER # 433 CHEMLAB REF #:6192 ORDER DATE: MAY 12 87 DATE RECEIVED: MAY 11 87 VIA: HAND DELIVERED CLIENT:TOBBEN SPURKLAND PE ACCT NO: TOBBENP BILLING ADDRESS. 203 W 15TH AVE, #C-203 ANCHORAGE, AK 99501 (907) 279-3916 / CONTACT PERSON: ATTN ACCTS PAYABLE (907) 279-391b PURCHASE ORDER # VERBAL REO # PROMISED: MAY 13 87 SMPLS RECEIVED: MAY 11 87 ORDERED BY: SPECIAL INSTRUCTIONS: COPIES HELD FOR PICK UP. Chemlab Client Parameter Sample # Sample Description Matrix To Test 1 1-3, B3 S. HILL-TOTALCOLIFORM L3, B3 S. HILL 1 20153 -NITRATE -N 9719 Units Result =====-- _=--� _= v col il00ml A. WELL DATA MUNICP MUNICIPALITY OF ANCHORAGE (MOA) ENVIRO AUTyOPANCHIZA/,+,Lq�T1�H� AUTHORITY APPROVAL (HAA) NMEIVTAL SERVICES QIV AECKLIS 64FEBRUARY 1984 44AY1319 tioi 13X3 -SOV'rd f011AL 8� Legal Description: r �.c 615 /R PIS R���� UfD Well Classification - If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) — Date Completed Yield 7 b Total Depth 59 Cased to ✓67• dr Depth of Grouting Static Water Level Ar ie-siavi Pump Set At O's Casing Height Above Ground Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) %� Depression. Around Wellhead (Y/N) f`s/ Separation Distances from Well: To Septic/Holding Tank on Lot JA 5 ; On Adjoining Lots > /e-eD To Nearest Edge of Absorption Field. on Lot /09- ; On Adjoining Lots 7 To Nearest Public Sewer Line NONE To Nearest Public Sewer Cleanout/Manhole N0 IyE To Nearest Sewer Service Line on Lot i �D Water Sample Collected by "77-c- Date 6/-'1/a7 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installed Size d No. of Compartments r lea Standpipes (Y/N) Air -tight Caps (Y/N) x Foundation Cleanout (Y/N) Depression over Tank (Y/N) N Date Last Pumped NIA Pumping/Maintenance Contract on File (Y/N) �f,� ; for N/A Holding Tank High -Water Alarm (Y/N) h/A Temporary Holding Tank Permit (Y/N) � Separation Distances from Septic/Holding Tank To Water -Supply Well I %Z5 To Building Foundation 6 9 To Property Line —.To Disposal Field To Water Main/Service Line > To Stream, Pond, Lake, or Major Drainage Course 2 -Ow Comments Page 1 of 2 72-026(11/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Type of System Desi�1] Design 8 Date Installed %2 e3 5 Length of Field f X 7 Width of Field Depth of Field 3 Gravel Bed Thickness G r! Square Feet of Absorption Area r --Standpipes Present (Y/N) Depression over Field (Y/N) Date of Last Adequacy Test N�A L N�L�ty Results of Last Adequacy Test W/A Ne to t' i Separation Distance from Absorption Field To Water -Supply Well 10a To Property Line /-3 To Building Foundation 73 To Existing or Abandoned System on Lot helA ; On Adjoining Lots % /U 0 To Water Main/Service Line % 717 To Cutbank (if present) 6el^- To Stream/Pond/Lake/or Major Drainage Course �> l 6t7 l C D. LIFT STATION N 1.sS i( Date Installed 8-5 Dimensions 3 6 X 426, Size in Gallons nZ 5;(-p Manhole/Access (Y/N) __ Y "Pump On" Level at Yo it "Pump Off' Level at it High Water Alarm Level at A16 Vent (Y/N) _ Tested for Electrical Codes (Y/N) Comments ** Check Permitted Bedroom Rating Against HAA Request ** Pumping Cycles during Adequacy Test. Meets MOA I certify that I have checked, verified, orconformed to allA and HAA guidelines in effect on the date of this inspection. Signed �A s Date Company MOA No. < Receipt No. �O O / p O ga ��c.••••r, i, Date of Payment 1 B : Tt1 Amount: $ L� f.,Y • • ......... ' ° Engineer's Seal o.22?5 E: a t1f?�o JUNE 2b. 1911 Page 2 of 2 72-026 (11/84) 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 1. GENERAL INFORMATION 2. Application Date k.4A ap,k�v (a) Legal Description (include lot, block, subdivision, section, township, range) _ Le) -h: '5F51<-5 Scr . WI (is S@L- a5 I laN' fzau% Location (address or directions) (b) Applicant Name•Sea# Sear-" Telephone: Home Byd -690 !1 Business Applicant Address I & LID ®wi ©LAAA L4 4&X (c) Applicant is (check one): Lending Institution ❑ ; Owner/builder ❑ ;Buyer ❑ ;Other ❑ (explain); (d) Lending InstitutioniVwc(d Telephone Address ,c (e) Real Estate Company and Agent N r Address Telephone (f) Mail the HAA to the following address: TYPE OF RESIDENCE Single -Family Multi -Family El Number of Bedrooms -� Other , 3. WATER SUPPLY Individual Well/Jif 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 11 Community ❑ Holding Tank ❑ Note: f 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 PROVIDIN -INSPECTIONS, TESTS, FILE SEARCH, Di.. A 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 i s ection. yc 110 Name of Firm Telephone 3� Address l rte! Date I ong beer's Seal 6. DHEP ed for APPROVAL =J/i1� Zl Z;W Approved for '?t,�L..</.bedrooms by �/`%t Date /��• Approved Disapproved Conditional Terms of Conditional Approval 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) f v> HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST FEBRUARY 1984 2 j ,l /Y Legal Description: A. WELL DATA'®��p J Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present (Y/N) OK Date Completed Yield Total DepthN59� Cased to f Depth of Grouting Static Water Level�✓ f " v r mp Set At dAZZ�d 7" ( A> Casing Height Above Ground '�u Sanitary Seal on Casing (Y/N) Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) ,V Separation Distances from Well- To 7 To Septic/Holding Tank on Lot / 2� ; On Adjoining Lots To Nearest Edge of Absorption Field on Lot On Adjoining Lots To Nearest Public Sewer Line To Nearest Public Sewer CleanouVMan hole To Nearest Sewer Service Line on Lot > ; Water Sample Collected by Date 7 Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA t Date Installed Size — No. of Compartments Standpipes (Y/N) Air -tight Caps (Y/N) — Foundation Cleanout (Y/N) Depression over Tank (Y/N) 1 Date Last pumped `T+n�/✓ Pumping/Maintenance Contract on File (Y/N) ;for j Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) NJ� Separation Distances from Septic/Holding Tank: To Water -Supply I Well /25 To Building Foundation -� i To Property Line } / To Disposal Field To Water Main/Service Line To Stream, Pond, Lake, or Major Drainage Course >��Ib Comments Page 1 of 2 72-026(11/84) �.... C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata S Type of System Design 1.410 Date Installed 10 12 Length of Field%%�G�Ff Width of Field /4 iso% 6eW) %y� Depth of Field Gravel Bled Thickness �R , Square Feet of Absorption Area 40�.,� .T/T� Standpipes Present (Y/N) V Depression over Field (Y/N) Date of Last Adequacy Test smll_� w/I Results of Last Adequacy Test Separation Distance from Absorption Field: Tq Water -Supply pp y Well /O2— To Property Line To Building Foundation % 3 To Existing or Abandoned System on Lot ; On Adjoining Lots x/07 To Water Main/Service Line > �� To Cutbank (if present) ZY 14 To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments X" ,> e /.scZ 0 g? D. LIFT STATION Date Installed ��� Dimensions Size in Gallons 20 Manhole/Access (Y/N) Y "Pump On" Level at ��AA �� Or S� a w °Pump Off' Level at /Z7xx0M ,&2x",4 ��(��/�( High Water Alarm Level at 46��Motmm of Crlllyvlq Vent (Y/N) -- Tested for 71 . Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) { Comments ** Check Permitted Bedroom Rating Against HAA Request ** I certify th t I ha checked, verifie41pr conformed to allM A a d //HAA guidelines in effect on the date of this inspection. Signed Date �a�b Company MOA No. Receipt No. Date of Payment L Amount: $ \,oS Engineer's Seal . 'i 2225-0 4 Page 2 of 2 NE 2S, t�%1 72-028 (11184) CONSULTING ENGINEER ��aLG,�aDs Poco /(L03 W. 15th AVE "C" SUITE 203 ANCHORAGE, ALASKA 99501 TELEPHONE: (907) 279.3916 R E S I D E N T I A L W E L L I N S P E C T I O N LEGAL: LOT 3, BLOCK 3, SOUTH HILLS LOCATION: 7640 OUR OWN LANE OWNER: SCOTT SELMAN TYPE OF WELL: SINGLE FAMILY WELL LOG AVAILABLE: YES INSTALLATION REQUIREMENTS METd YES - WELL YIELD FROM WELL LOG: 7.5 GPM PUMP YIELD: 7.5 GPM DATE OF INSPECTION: INITIAL: JULY 2, 1986 FOLLOWUPS: JULY 28 AND AUGUST 11, 1986 TEST PROCEDURE: WELL WAS PUMPED AT A CONSTANT RATE OF 7.5 GALLONS PER MINUTE WHILE THE DRAWDOWN WAS MONITORED WITH AN ACOUSTIC PROBE. THE WELL WAS PUMPED TILL THE DRAWDOWN STABILIZED. STATIC WATER LEVEL WAS FOUND AT TOP OF WELL (ARTESIAN). ONE HOUR OF PUMPING AT 7.5 GPM CAUSED THE WATER LEVEL TO DROP 56 FEET. RECOVERY TOOK 25 MIN. TEST FOR COLIFORMS: WATER WAS TESTED FOR COLIFORM BACTERIA ON JULY 3 AND Z L1986. TESTS WERE NEGATIVE. TEST RESULT: THIS WELL MEETS- THE REQUIREMENTS OF THE MUNICIPALITY OF ANCHORAGE. The Municipal requirement for well flow is 150 gallons of water per bedroom per 24 hours.This well surpasses this requirement. The assessment of the condition of this well applies only to the conditions as of this date. The flow rate of the well may change due to subsurface conditions that may not be observed from the surface, and changes in land use and other factors that may impact the conditions of the aquifer feeding the well. 0F At g*•r.STHt r, � ,. u. 2225-V UNE 25, 1971 „ sy'a TELEPHONE: 272.4114 ALASKA GEOLOGICAL CONSULTANTS ENGINEERING GEOLOGY * MINING * GEOPHYSICS * GROUNDWATER til PETROLEUM 2227 SPENARD ROAD ANCHORAGE. ALASKA 99803 May 8, 1969 Mr. Mitchell J. Dickerson 4420 Emard, Space 4 Anchorage, Alaska Re: Percolation Test, Lot 3, Block 3, South Hills Subdivision Dear Mr. Dickerson: This letter is to certify that a percolation test has been conducted on the above-mentioned property. The test was performed in a twelve -inch diameter, twelve -inch deep test pit in the bottom of the proposed absorption field. Location of the test pit, the log of the test pit and percolation data are shown on the attached sheet. This test was made in accordance with the Greater Anchorage Area— Borough Health Department specifications as prescribed in Appendix B of the National Plumbing Code, 1962 Revision. Very truly yours, ALASKA GEOLO^TCA;. ^ONSULTANTS 1, BGP:js uce G .Purcell Attach. BY.... .....DATE ... 11 ........ I ........ M. T. MCKEYRSON PR0PjTRTY,,%.A SH'EET NO-- ............... OF_............ ........... ------------ ---------------- ---------- - ''` CHIhD. BY.................DATE..................... .... ..... . ... JOB NO. J)ercolaljon Test ................................... 0 N�3 �W DCkM k 0 P P'N a Q IX-gar: