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Home My WebLink AboutSTEVAHN BLK 1 LT 2A4-LUAV, C-%\ o1%-) , J,�aA- (Do( MUNICIPALITY OF ANCHORAGE r' On -Site Water & Wastewater Program PO Box 196650 4700 Elmore Road I Anchorage, Alaska 99519-6650 Phone: (907) 343-7904 Fax: (907) 343-7997 http://www.muni.org/onsite OcI'artnr c I I t FNCHORP�� On -Site Wastewater Disposal System Permit Permit Number: OSP241192 Effective Date: 9/25/2024 Work Type: Septic Upgrade Expiration Date: 9/25/2025 Tax Code Number: 01742209000 Site Legal Address: STEVAHN BILK 1 LT 2A G:2840 Site Mailing Address: 12440 RIDGE PL, Anchorage Owner: COAK KOLDEWAY ALASKA COMMUNITY Lot Size in Sq Ft: 15652 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 3 This permit is for the construction of: Q Disposal Field CSI Septic Tank ❑ Holding Tank ❑ Privy ❑ Private Well ❑ Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing -By: 55(Ae-J % AX 4 Issued By: Date: Date: Municipality of Anchorage P.O. Box 196650 0 4700 Elmore Road Anchorage, Alaska 99519-6650 a (907) 343-7904 a Fax (907) 343-7997 http://www.muni.org/Onsite Development Services ii s On -Site Water and Wastewater Program * * * * VARIANCE/WAIVER REVIEW * * * * Waiver#: OSV241053 COSA#: PID#: 017-422-09 Legal Description: Stevahn Blk 1 Lt 2A Engineer: Mike N. Anderson Permit#: OSP241192 Your request for a waiver of the required 10 feet horizontal separation from the absorption field to the property line has been approved. The approved separation distance is 1.0 foot. This waiver approval applies to the proposed absorption field only. Any future upgrade to the on- site wastewater disposal system will require all separation distances be met or another approval from this department. Waiver is Granted: X Waiver is not Granted: Date: QZ-25 Z` Approved by: A_ Name of Reviewer **** VARIAN C E/WAIVER REVIEW **** MUNICIPALITY OF ANCHORAGE Development Services Department Phone. 907-343-7904 On -Site Water & Wastewater Section Fax- 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 017-422-09 Property owner(s) KOLDEWAY Mailing address 12440 RIDGE PL Site address SAME Day phone Legal description (Sub'd., Block & Lot) STEVAHN BILK 1 LT 2A Legal description (Township, Range & Section) Lot Size 15652 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (Z all that apply) Absorption Field nx Initial ❑ Single Family (SF) nX (w/wo ADU) Septic Tank nX Upgrade nX Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: Date of Payment: 20 7_ Receipt Number: Permit No. V5P 2- � / t 5 -Z_ Waiver Fees: _# 2Z 5 - Date of Payment, Receipt Number: Waiver No. O5 V Z Li JC) 5 G:\Development Services\Building Safety\On Site Water and WastewaterTormsUient Forms\Permit Application.doc Sept. 17, 2024 Municipalities of Anchorage On-Site Water and Waste Water Section 4700 Elmore Rd Anchorage, Alaska Phone 343-7904 Re: New septic permit & 1’ lot line waiver Legal:STEVAHN BLK1 LOT 2A To whom it may concern: This is a request for a septic permit on the above referenced lot. A test excavated and found silty gravel (GM) for the 16-foot depth with no water during or after the 7-day monitoring period. A simple deep trench has been designed, see the site plan. The perc rate of 20 minutes per inch. We are also requesting a 1’ lot line waiver for the two leach fields to allow installation of the trenches perpendicular to the slope. This waiver will not impact any of the surrounding properties, see the site plan. Our justification for this waiver is this location is the best spot for a new system (good soils and drainage) and will not impact any surrounding properties now or in the future. The lot slopes gently about 5 percent from the east. None of this proposed design will impact the surrounding neighbors. Sincerely Michael N. Anderson, P.E. 4661 Natrona Anch, Ak 99516 Ph 727-8864 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241192, Deb Wockenfuss, 09/25/24 SEPTIC FIELD SECTION DESIGN CRITERIA: 8' EFFECTIVE 3 BDRM X 150 = 450 GPD SOILS = 450/0.6 = 750 GPD 750 GA/ 2*8= 47 2.0' WIDE (2) 23.5' LONG (1) TRENCH 10' DEEP 1. 0 ' 2.0' -10 -2.0 MOUND OVER FILTER FABRIC SEWER ROCK 4.0"Ø PIPE GRADE 1"=100' PROPERTY LINE PROPOSED DRAINAGE FIELD EXISTING HOUSE EXISTING WELL 100' RADIUS SCALE: DJRDRAWN: DATE: STEVAHN BLK 1 LOT 2A Anchorage, Alaska KOLDEWAY 8/1/2024 BENJAMIN RD & INSULATION RI D G E P L A C E VACANT LOT -1.0 -16.0 GM OG TH#1 NO WATER MAY 2024 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241192, Deb Wockenfuss, 09/25/24 1"=50' NEW 1000 GALLON PLASTIC TANK, MAINTAIN 10' FROM FOUNDATION EXISTING HOUSE DRIVEWAY SCALE: DJRDRAWN: DATE: STEVAHN BLK 1 LOT 2A Anchorage, Alaska KOLDEWAY 8/1/2024 SEPTIC AREA DCO AFTER THE TANK W/ VALVE TO OLD SYSTEM WELL WELL WELL MAX 5% TH#1 CO/MTCO/MT SEPTIC AREA 1 0 ' U T I LI TY E A S E M E N T EXISTING PADIO EXISTING BAY WINDOW ON THE 2ND FLOOR LOT LINE WAIVER REQUESTED FOR 1' FROM PROPERTY LINE VERY SHALLOW 1' DITCH ALL EXISTING PIPES TO BE LOCATED FOR NEW ASBUILT MAINTAIN 10' FROM FIELD TO BLDG FOUNDATION 18' BETWEEN TRENCHES Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241192, Deb Wockenfuss, 09/25/24 Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP241192, Deb Wockenfuss, 09/25/24 N89*53'30"E 124.85' •1 1 00. 25 25 WELL 1" == 30, _03 o6 rn LOT 2A BLK 1 Ln n I28.0' L6 3'x22' PROW PAVED W0 ' BRICK D _ LJ W < TIO L -Li PATIO LLJ -0 CL 3, X 1 00 00 0X CANT LLJ 0 LLJ t4') SEPTIC 0 7-Q PIPE 0 (typ) 0 (D (D V) 2'x1 31 28.0' 48.6' V) CANT 1 N89"54'00"E 124.85 0 BENJAMIN ROAD � ANCHORAGE RECORDING DISTRICT, ALASKA AS -BUILT OF: STEVAHN SUBDIVISION LOT 2 A BLOCK I PLAT 70-123 SURVEY CERTIFICATE: 1, John L. Schuller, Have conducted a physical survey of this property as shown on this drawing, and that the � improvements situated hereon are within the property lines and no enchroachments exist other than noted. Under no circumstance shouli any information on this drawing be used for construction of fences, structures, improvements, or for establishing boundary lines. EXCLUSION NOTES: It is the owners responsibility to determine the existence of any easements, covenants, or restrictions which do not appear on the recorded subdivision plat. WORK ORDER NUMBER: DATE: SCAU:E—MAIL $1 MAY 28, 2024 1 =30' schullerakOgmail.com 24-046 DRAYM BY: CHECKED BY: GRID NUMBER: Bock AGE- JLS SW2840 240162 -�- — FND MONUMENT 0 = FND I " IRON PIPE * = FND 5/18" REBAR W O.F �a ... 4 AW 00� oe 49TH A WA .................... ; • •® JPHN L. SCHULLER.- 0 LS -10408 6, AW �a Of e Q, �- L AN)�? V SU S, 1831 Talkeetna Street Anchorage, Alaska 99508 (907) 227-1455 office (907) 274-4992 fax Oewki/ewat dww1 w bgoPt*.M 1laMm ieftfy OWN . On•�No NMw ♦ waste" her" 4700 L*Ww St ta► 0.O.11++1 "Mo Aeck"s. A1C §fll$-NEO • ' maw �LµDI Pump Igo tallatiarLou • >Px-s'19-7997 WeU D Mj firms Number.Tran of Molal t•&..a i&w lreJMRR NamInlloll -L2 p� y� N�au � A�Aesax ` -an J� ,�bu �► '2 � 1 y O a /G him WuU� Da1et..L•.rri:.0� Pum►1ahM��tlOalew1yl+efWillCadall �,+ htM tsmP pUtOAlettttr'/ Nem ��ar 1 Tlll@wAtelw[DWWDl0w /Q f*l TitlenAdaytaMnnbttmrrl�Namtt nn{ n -ti+ rxsi�:^d J ?ltlotlAOa;talmrlaUen 1 � rx�crl�••, WeIIDhlt�etersD/aaCw}!!!ss! pXYu 0 No 1 AO& oft —e 11%C7 Ce,useaM+ CALL FOR SERVICE - Complete Weler Sytam SaMao - AAROW PUMP & WEIt SERVICE, LLC __.. ANCHORAGE OR" WILLS EAGLE RIVfiR ~+ (B07) 3M.0355 (Wn 522.8335 Attatleft Oka loot wildw "t t WA& a pon0 kd4xtlam left laDAD W" 30 dqn edlear Uwwllokik TiT'd L66Lfib£:Ol :W021d ULO+£0 L002-6-AUW j, 7,1 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 NAMEJJ �/ / //� PHONE Eyy ❑ UPGRADE MAILINGADD13ESS LEGAL DESCRIPTION Lai LOCATION NO. OF BEDROOMS Uy DISTANCE TO: WellAbsorption Al& /�'V. area S60 Dwelling ,f%0! / •N' PERMIT NO Y'/Q 3 Y% WQ Manufacturer 1��2 C� MateaalL No. of compartments S /l n Liq. capacity in gallons IF HOMEMADE: Inside length Width Liquid depth �O'2 DIST O, Well 'ng MI N 2z FQ- Man ctu r al rq i ap ci al o o w= DISTANCE TO: Well y� j �,nJ Foundation — Nearest lot line PERMIT NO. � u Z P e w No. of lines Length of each line J Total len h of lines / Trench width 3— i =U" Distance between lines ¢ p Top of tile to finish grade Material beneath tile/ O y inches Total effective absorpt on area L ength Width Depth ERMIT NO. 9 Q F- wd Ty eof crib Cri diameter Crib depth T l effective abs pilon area W w DI NCE Well Buildin oundation t 1 � Nea e J J Class�/J(u� !CC Depth Driller Distance to lot line PERMIT NO. w DISTANCE TO: Building foundation Sewer line Septic tank Absorption area(s) .J 6 OTHER PIPE MATERIALS A/ e 3a 3 SOIL TEST RATING Q INSTALLER,�/ / REMARKS o.dz- a t/ L APPROVED _ DATE LEGAL %2-013 (Rev. 3/78) RETURN TO: Division of Geological and G,��,"Ical Surveys OGGS). 3001 Porcupine Drive (Tele, .. 277-6615) Anchorage, Alaska 99501 M ATE R W E L L R ECO 0. 0 Or l l ling Company Name Foss Drilling U.S.G.S. Local No Drilling Permit No A.D.L. No STATE OF ALASKA DEPARTMENT OF NATURAL RESOURCES LOCATION Ur WCLL - - ' Ta. Borough Subdivision �A�� Anch. Stevahn Section No. Township N/S Range E/W meridian lc. Distance and Direction from Road Intersections Street Address and Area of Well Location 3. OWNER OF WELL: Charles Jackson Address: SRA BOX 2401 Anch., Ake 99507 2. WELL LOG Feet Below Surface Material Type Top Bottom Q 1 4. WELL DEPTH: (completed) Surface Elevation70ateof 49 ft/{ 5, Cable tool ❑ Rotary ❑ Driven ❑ Dug ❑Auger ❑Jetted El Bored ❑Other: hardness. Bedrock:light green color 19 40 6. USE: INDomestic [:]Public Supply ❑Industry El Irrigation 11 Recharge ❑Commercial E] Test Wen []Other; med. hardness, with water. edrock:blue-grey color, med 40 49 ardness. 7, CASING: El Threaded &IWel ded in. to 20.5 ft. Depth Weight 17 lbs/ft. in. to _ft. Depth 8. FINISH OF WELL: open hole Type: Diameter: Slot/Mesh Size: _ Length: Set between ft. and ft. Fittings: 9, STATIC WATER LEVEL: 1 5 ft. ❑ Above M Below land surface Type of Measurement: sand line 10. PUMPING LEVEL below land surface 40 ft. after 2 hrs. pumping 10 9-P•m. ft. after hrs. pumping 9.13.m. 11. WELL HEAD COMPLETION: ❑ In Approved Pit ® Pitless Adapter inches above grade 12. GROUTING: Well Grouted: ❑ Yes ® No Material: ❑ Neat Cement ❑ Other: 13. PUMP: (If available) HP Length of Drop Pipe ft. capacity 9-P Type: ❑ Submersible [:]Reciprocating ❑ Jet ❑ Other: 14. REMARKS: 15. WATER WELL CONTRACTOR'S CERTIFICATION: This well was drilled under my jurisdiction and this report is true to the best of my knowledge and belief: Foss Drilling AAAA O8 Registered Business Name Contract License Num-- Address:90 Chu ach Dr nchor e k 0 Signed: - Date: Authorized Representative - __ ._._ .___ ,...._.l....,.... u.iTc - Srate OGGS. PINK - Driller, CANARY - Customer r° -F o_e r-4 T A. I F ° fzl F_. I 'T- (A F0 DEPARTMENT 05, HEALTH AND ENVIRONMENTAL PAPTECTIT-4 '`c 'L STREET, ANCHORAGE, AK:. 9'v. I � v r 264-4720 /� 1,1 Er F__ t__ i? VA E A CA FJ --- _..• 1" -g- E_. 0 F= LA E_- F� , =° F F__ FT" 10I _T_1010L `l PERMIT NO. ( 810321 ) APPLICANT MT. ENTERPRISE _RR BOX 2401 345-0279 LOCATION RIDGE S.T. OFF UPPER: ? HUFFMAN LEGAL LUT 2A Bl STEVRHN SUB LOT SIZE 22000 SQUARE FEET TYPE OF SOIL ABSORPTION SYSTEM I_: TRENCH MAXIMUM NUMBER OF BEDROOMS = = SOIL RATING (SQ FT%BR)= 180 THE REQUIRED SIZE OF THE SOIL ABSORPTION SYSTEM IS: � 3� 10. E07 F -F r-4 u' ca @n t-=� °= E^ L_ C:_° Fv F=" -Y- F -F -_. ®=° F THE LENGTH DIMENSION IS THE LENGTH (IN FEET) OF THE TRENCH OR DRAINFIELD. THE DEPTH OF H TRENCH OR PIT IS THE DISTANC:E BETWEEN THE SURFACE OF THE GROUND AND THE BOTTOM OF THE E{CAVATION (IN FEET). THERE IS NO SET WIDTH FOR: TRENCHES. THE GRAVEL DEPTH IS THE MINIMUM DEPTH OF GRAVEL BETWEEN THE OUTFALL F'IF'E AND THE BOTTOM OF THE EXCAVATION ON FEET). K F= CA 8_J I F;? F= E> ST EE F--'• T 1 (T -T- 1=1 01 K = :E n" F= = !L CA CA CA A_ -A F=A F_ F_ CA r4 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. ------ -1-01CA ":- To :" ". r -F °F F 7A0 -F 1 A=A54=- HF=_E= FTErCA/_P I KE=E-" --- - BACKF'ILLING OF ANY '_SYSTEM WITHOUT FIt+IAL INSPECTION AND APPROVAL BY THIS DEPARTMENT WILL BE SUBJECT TO PROSECUTION. MINIMUM DISTANCE BETWEEN A WELL AND ANY ON --SITE SEWAGE DISPOSAL SYSTEM IS 1.00 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 THE DEPARTMENT WITHIN 30 DAY OF THE WELL COMPLETION. A OTHER: REQUIREMENTS MAY F'F'L4'. SPECIFICATIONS ANDCONSTRUCTION D I AGR:At1'= ARE AVAILABLE_ TO IN_-UR:E PROPER INSTALLATION. F=° F= F ' r°'F lwi E= ;K; F=° T F=' E= == C_, E= CT EE. rl E3 F ` FZ 1 AL = A_ _=y E3 -11 I CERTIFY THAT 1: I HM FAMILIAR WITH THE REQUIREMENT' FOR ON-SITE SEWERS AND WELLS AS SET FORTH BY THE MUNIC:IPALITr' OF ANCHORAGE. I WILL INSTALL THE SYSTEM IN ACCORDANCE WITH THE CODE". 3: I UNDERST TH THE ON-SITE SEWER 4"=TEt9 MAY REQUIRE ENLARGEMENT IF THE RE'IDENCE 'Et'1i LED TO -INCLUDE MORE THAN 3 BEDR:CiCit't'=. SI APPLI ISSUED BY ---------- --- --- ------ -- ENTER:PR:I SE _DATE/✓� F7 --- V? 0 D; ei0 ' XEmq J�,i-S CL/�'y a»o �iVGKi.•r s.t (3reu�r Or�wr•es 3r. •e 6� � S+-.d� >.ra�•v..lu�pe...e S�/f i9P�worr C/e..•. SP �rir.n. 6tsr��//o' Jr�srd(J/lrw�6T�M�J- SW fe Swsr �I7�M Hl�/ 1 Sesr A"o7W'Ri/IG Y�1s. /.re ryJO 3 tee t. BMVH• S�I/re �C iN 41Cy�p/i�HI B I �ENSE Jic ry h1.17ERivc •v�s�Md .7 .�� 4 ��P�a.� �.Y�YdL, 5� �.�s✓v/sasi�r� IS!j By s c� it - � /EN7 pua ✓.ve/rtrN U/ldt �4/FM�/N lOGA7rsry � 1/s ,?H !3a•eK I STsvrrMN --� Su$D/rr Jri�t; .�/ea ra<O E.vr> // S, I• W�IG� Haf/M>'N H�GtS�OE T%Rrrtr' O.Sn..avS. 4 Q' G.r 7� prw.. os lire N••s ra•/ ��/�/ � Viri �� Ga $sw OF �FINIM �,.i /.•> �'�I aaoaM / b Q %E37 7,y `f �e>rN..,r 7� l3.PedER4 ��•ilJs � �MTE Sf i�// f / � 0 '�� s� �L.a 4reM✓a'O �LNI/MM/NE �� Ti/n6 ai Ti/.,.r X�rra/.r6 i%ROy /N r�Em'rwr?.1'S ,'�c JyD/N6 NTERYSiL /NC.Y6t'S �9 ff[ Iia Rc /!•aS !/e rsaO tJ-, > /Yi?sm orr' 3/Aw SrNR� Prts•.rN Pir /row Sorer o9S6.t YN -Wo IV. f/ i /✓!lA rv6 //J' 9.J'f't Tfdcsar 06. ow rvrr 1 /✓c'W .jO,r/as PRlr/.�R D/rw' !✓.+ea of 7.rd"NON/ NI altP/Ni iN SiNnv T W P, /)/I b (!P/Ni /YI r60 /N /lir / Fy iA6�NlN, 1,Iw4 dC PRy, pl 7N1J 6GlrN ��//✓. 4N/•N rr sr eF w•r raft >rn-irwa s>�,rs �lr7 /, 43 rJ N/r �A'Ml u.te^N ACS, N, efr'�D6�✓�6 Rlvp y /•7/ /`�` i•• of /✓Nre'.r 7rr4r46', 8GC6/N BN�aeR. ,e.... •Ji a.z3�r• 12 re f.aa 30,.,�, ,,9r r .1 z" nW p.Ral% z Jf/ /• c9 o•jo T � )2,cRC rail>e /.� 6J /iri.•./ye.v C?/M �.PhPH ES7rw••Y �E .�dy7 urREp .GljJoRP7ioN /'�XCA7 = /$O Sf />6R 136DR0�h j -z4- MUNICIPALITY OF ANCHORAGE • DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel l.D.# la\i- L\,qQ -nS 1. GENERAL INFORMATION Complete legal description n ' `A _A_� HAA# W�991nL5I Location (site address or directions) 12440 Ridge Ham Rick Thom (wk) 271-4497 Property owner pbon Day phone m) 345-3511 Mailing address 12440 Ridge Place Anchorage Alaska 99516 Lending agency Mailing address. Agent Address Unless otherwise requested, HAA will be held for pickup. 2. NUMBER OF BEDROOMS: 3 y 3. TYPE OF WATER SUPPLY: Individual well x Community well — Public water Day phone Day phone NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site x Holding tank Community on-site Public sewer 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 M21 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval application shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I furtherverify that based on the information obtained from the Municipality of Anchorage files andfr � y I vestigation and inspection, the on-site water supply and/or wastewater disposal e em is in ompliance with all Municipal and State codes, ordinances, and regulations in ec�n the to of this inspection. Name of Firm — Address Engineer's signatu 6. DHHS SIGNATURE LApproved for Disapproved. 2�--� �� bedrooms. Conditional approval for Additional Comments Phone OE Z�?7 /-` Date bedrooms, with the following stipulations: Date 9 — q 5 file] I • The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in orderto satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for er ors or omissions in the professional engineer's work. Municipality of Anchorage Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Legal Description: �o i ZA 576_VRww 5/D Parcel I.D. � � 7 A. Well Data Well type iACl✓/4/ If A, B, or C, attach ADEC letter. ADEC water system number Log present V) ck_S Date completed s Z Driller Total depth `r - Sanitary sealdy_/PI) -* C_AS6-ZD ja Cased to 20 ''57 Casing height �Cs S Wires properly protected") 1) I �� i3ED[2vc 6, FROM WELL LOG AT INSPECTION OF ANCHOMGE Date of test -5- '12- di( Static water level S / aaoc.,) Well flow / o- g.p.m• Pump levell �% K, SEPARATION DISTANCES FROM WELL TO: Z I,/,'NICIPAU7Y 3 ViRONMENTAI SCESERVIDIVISION SEP 1 3 1993 Z . -5, g.p.m. �� RECEIVED Septic/holding tank on lot �� t ; On adjacent lots 46>0 �f Absorption field on lot /UU �� ; On adjacent lots /(�n (- Public sewer main /c� 191t SSE? -r Public sewer manhole/cleanout Sewer service line ZS/f Petroleum tank WATER SAMPLE RESULTS: Coliform �/�Oy /�nnNitrate 2 Date of sample: ��Z ( 3 Collected by: B. SEPTIC/FITANK DATA Other bacteria' ✓� Date installed S Tank size /000 64(- Compartments Z- Cleanouts / 1) (tf-s _Foundation cleanout 61 / Depression ( �� High water alarm (Yf dl �' ' Alarm tested �) N� �ld (Y/ Date of pumping �/Z �C/ 3 Pumper 4 t f " 6 SEPARATION DISTANCES FROM SEPTIC/#6 TANK TO: Well(s) on lot & On adjacent lots Foundation S To property line Absorption field S /� Water main/service line Surface water/drainage /7� 72.026(3/83)' Front CONTINUED ON BACK PAGE C. LIFT STATION V i✓Cs / 2�OCz" 1 Date installed Manufacturer Size in gallons Vent(Y/N) High water alarm level Meets MOA electrical codes "Pump on" level "Pump off" Level at Cycles tested SEPARATION DISTANCE FROM LIFT STATION TO: Well—on lot On adjacent lots Surface water D. ABSORPTION FIELD DATA Date installed Z Soil rating (GPD/Ft2) Q 2 System type acwc 11 Length _2� / Width ,� if / Gravel thickness ��z r Total depth L3' Total absorption area Sc00 Cleanout presen Y/) 'K Depression over field Date of adequacy test Result as fail) for �y�z;Bedrooms -T len Water level in absorption field before test Sy i¢ After test _64" Peroxide treatment (past 12 months) (Y/N) N+>/t-A�:7 it /yUwAJ If yes, give date ✓'J SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /00 �� On adjacent lots (C -D L!> 1_�— Property line 0 / r To building foundation To existing or abandoned system on lot On adjacent lots ZU i� Cutbank ZJO X�6 /°2(45& -Cater main/service line -Z Surface water lOc7 r� Driveway, parking/vehicle storage area sU 1'7� Curtain drain e` KNOaJ�J f N WP� C 7o N/ ✓ ON -CT S1I r1 F1 E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or c�gier(ned to all MOA and HAA guidelines in effect on t�6 atwof-this inspection. Date of Payment 9-r3-93 Receipt Number2s1 q(O0 ��) 72026 (3/93)' Back Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE Department of Health & Human Services • DIVISION OF ENVIRONMENTAL SERVICES - " 343-4744 CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING Parcel I.D. # 017 -yam- /N HAA # 8 - 4.6-11? 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lot, block, subdivision, section, township, range) Lvoi 2"Fr 4119111111W = r N �9%E G'AON_!�;c 2!KlIRI-II0311 Location (address or directions) (b) Property owner Dal/; 0o Lar�Wore Telephone: (home) Business Mailing Address I2y',D Qi _P /a, (c) Lending Institution 2 X ( vtic� Telephone Mailing Address (d) Real Estate Company and Agent Address 30-0 e) A S 4.1_� y Telephone (e) Mail the HAA to the following address: (or check here �V if hold for pick up.) List contact person and day phone number below: A /'? 2. TYPE OF RESIDENCE Single -Family Y( 3. WATER SUPPLY Number of bedrooms 3 Individual Well P�_ Community ❑ Public ❑ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site Ip. Public ❑ Community ❑ Holding Tank ❑ Note: If/community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legailty and status. 72-025 (Rev. 7/88) Page 1 of 2 e� 5. ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation of this Health Authority Approval shows that the on-site water supply and/or wastewater disposal system is safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance with all Municipal and State codes, ordinances, and regulations in effect on the date of this inspection. Name of Firm�i e biz,,,� Su,(.t.dc t_xt4_d i�, 1.= Telephonen�� q 4�c e,4 Address 4203 x- r'Jl�f Date V `i d ✓ / 0l (W r. �i�•• Engineer's Seal ` • • ``c 2 i 6. DHHS APPROVAL Approved for �-bedrooms by r Date Approved 0( Disapproved Conditional Terms of Conditional Approval The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval cerificated based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors oromissions in the professional engineer's work. 72025 (Rev. 7/88) Back Page 2 of 2 r, JG,o�MUNICIPALITY OF ANCHORAGE (MOA) oe F Health Authority Approval (HAA) fi PNjP s CHECKLIST - FEBRUARY 1984 a :> 343-4744 ENV Legal Description: L D% - A 9-f I- VA a -N 00 A. WELL DATA "y Well Classification If A, B, C, D.E.C. Approved (Y/N) .� Well Log Present (Y/N) _ Date Completed "/ Yield ) Total Depth / Cased to 0-0 Depth of Grouting Ne)o'a Static Water Level Pump Set At 7)�� Casing Height Above Ground /9 I Sanitary Seal on Casing (Y/N) �Z Electrical Wiring in Conduit (Y/N) Depression Around Wellhead (Y/N) I`f SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot d00 -# -;On Adjoining Lots / To Nearest Edge of Absorption Field on Lot fes' On Adjoining Lots To Nearest Public Sewer Line �///A To Nearest Public Sewer Cleanout/Man hole .3 -- To Nearest Sewer Service Line on Lot y Water Sample Collected by Date f t Water Sample Test Results Comments SEPTIC/HOLDING TANK DATA Date Installed Size 100D No. of Compartments i Standpipes (Y/N)Ai)r-tight Caps (Y/N)- Foundation Cleanout (Y/N) Depression over Tank (Y/N) '7 Date Last Pumped I)'Zeth0.r"l e I'S Pumping/Maintenance Contact on File (Y� A //N) NVA ; for /Y / j' Holding Tank High -Water Alarm (Y/N) /� Temporary Holding Tank Permit (Y/N) ' ' SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: To Water -Supply Well 100 t To Building Foundation To Property Line To Disposal Field To Water Main/Service Line �'- / 0 To Stream, Pond, Lake or Major Drainage Course tv Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata 8 o Type of System Design rc)—c JAG'/Y Date Installed ro�/ `� — Length of Field Width of Field "`'� / Depth of Field �z- Gravel Bed Thickness e4s ZZ Square Feet of Absortion Area ` Statndpipes Present (Y/N) 0 Depression over Field (Y/N) Date of Last Adequacy Test f f/,L l/ 1' Results of Last Adequacy Test > -:' .' 74,ulc T3--^/ -v, i;' " 3 SEPARATION DISTANCE FROM ABSORPTION FIELD: To Water -Supply Well /0,C)4- To Property Line To Building Foundation :' P To Existing or Abandoned System on Lot f�!�/a- ; On Adjoining Lots %=30 To Water Main/Service Line %?/L' To Cutback (if present) NA To Stream, Pond, Lake, or Major Drainage Course )y//-\ To Driveway, Parking Area, or Vehicle Storage Area > •3 Comments D. LIFT STATION Jgviyt✓ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Dimensions Manhole/Access (Y/N) "Check Permitted Bedroom Rating Against HAA Request`* "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed Company 6M cv a Engineer's Seal Date MOA No. >;. � Receipt No."(/0 /'a0 Date of Payment ZZ 9 Amount: $ / 1Z6 . r) d Receipt No. Waiver Fee: $ Date of Payment 72-026 (Rev. ]/88) Back Page 2 of 2 r� '11 MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTHORITY APPROVAL CERTIFICATE 1. General Information Application Date S-//& 1'e (a) Legal Description (include lot, block, subdivision, section, township, range) (b) ApplicantsNatte �CbU1C� 1� Telephjjone Applicants Address 16'Coil Dt( Co Pb "DOJO C) (c) Applicant is (check one) Lending Institution t.._._..- Obuilder ; Buyer r::T ; Other F—� (explain); (d) Lending Institution Telephone Address (e) Real Estate Co. & Agent _��2�b2Cyr Address A)IA- Telephone !2 (n "-7 13.2-- 2. Type of Residence Single-Family ►g4 Number of Bedrooms 3. Water Supply Multi -Family f:::J Other (describe) Individual hell Community Public Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Is the well adequate for the number of bedrooms specified in this HAA (Y N_ ) 4. Sewage Disposal Onsite K Public Community Holding Tank Is the wastewater disposal system adequate for the number of bedrooms (Y ) (Page 1 of 21 2-15-84 r-1 5. Engineering Firm Providing Inspections, Tests, Data and Information I certify that I have checked, verified, or conforrred to all MOA HAA Guidelines in effecton the atte of thi inspection. Sign 11 — Date /Ez Name of Signed by Date_ -A. A, (ENGINEER SEAL) 1-2 Approved for bedrooms Approved Disapproved Terms of Conditional Approval L^oy C. Reid, Jr. PROFES51�`�;� may^ By` L Date 4✓" O Conditional The Municipality of Anchorage Department of Health and Environmental Protection does not guarantee the continued satisfactory performance of the water supply and/or the wastewater disposal system. This approval indicates that, as of the validation date shown above, based on the data and information furnished by an engineer registered in the State of Alaska, the water supply and wastewater disposal system is safe and func- tional for the number of bedrooms and type of structure indicated. 7. Mail the HAAT to the following (DHEP SEAL) address: Lind) /,cl, ._Ss/L� KB2/d5/s (Page 2 of 21 2-15-84 I� MUNICIPALITY OF ANCHORAGE DEPT. OF HEALTH & MUNICIPALITY OF ANCHORAGE (MOA) ENVIRONMENTAL PROTECTION HEALTH AUTHORITY APPROVAL (HAA) MAY 18 1984 CHECKLIST -FEBRUARY 1984V 0, 17A7 DA. WELL DATA Legal Description: j Well Classification If A, B, or C, D.E.C. Approved(Y/N) Well Log Present Y N) Date Completed,9o2el 1/_ Yield VV Total Depth /y9 / Cased to e26'v Depth of Grouting Al Zd Static Water Level fj Pump Set At y0 Casing Height Above Ground AT Sanitary Seal On Casing ATA) Electrical Wiring in Conduit 61N) Depression Around Wellhead (y .) Separation Distances from Well: To Septic/Holding Tank on Lot 1,0a /* On Adjoining Lots 'f /DO To Nearest Edge of Absorption Field on Lot /01? " ; On Adjoining Lots#•/06" To Nearest Public Sewer Line /tj 1A To Nearest Public Sewer To Nearest Sewer Service Line on Lot Water Sample Collected By Water Sample Test Results Comments B. SEPTIC/HOLDING TANK DATA Date Installl/�eed`` _ Size ) a No. of Compartm2 ents Standpipes NY) Air -tight Caps 6-1>4 Foundati n Cleanout 7) Depression over Tank (-Y ) Date Last Pumped f // Pumping/Maintenance Contract on File (Y/N) A4 5t ; for Holding Tank High -Water Alarm (Y/N) % - Temporary Holding Tank Permit (Y/N) Separation Distances from Septic/Holding Tank: To Water -Supply Doll /O,¢':' To Building Foundation To Property Line //p 1-y To Disposal Field �� 62L ly2Zf b/ &-4 -) To Water Main/Service Line j$_ To Stream, Pond, Lake, cr Major Drainage [Page 1 of 21�`'`�Q`Q c pa 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata / k-11- Type of System Design Date Installed �/;?,/ Length of Field 3rd Width of Field Depth of Field -2mt? Gravel Bed Thickness go, 51 Square Feet of Absorption Area Standpipes Present (Y ) Depression over Field (Y NA Date of Last Adequacy Test .5 // 8_ Results of Last Adequacy Test Separation Distance from Absorption Field: To Water -Supply Pkll /0q/ To Property Line To Building Foundation �w 'O To Existing or Abandoned System on Lot LJ)?q On Adjoining Lots oo To Watar Main/Service Line N /4To Cutbank(if present) To Stream/Pond/Lake/or Major Drainage Course N/� To Driveway, Parking Area, or Vehicle Storage Area 70 11 D. LIFT STATION _A610£ Date Installed Size in Gallons "Pump On" Level at High Water Alarm Level at Tested for Electrical Codes(Y/N) Dimensions Manhole/Access (YM) "Pump Off" Level at Vent (YM) Pumping Cycles during Adequacy Test. Meets MOA ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I have checked, verified, or conformed to all MOA HAA Guidelines in effect on the date of this inspection. OF At, �� Signed N , �/I� VN fry Date (g 3 Company MOA No. `,�% 3- Z °n6 ENGTNEEi2� e0°°°� �4 o KB1/d5/s o roy C. R QQ If 11 No. 2211 [Page 2 of 21 2 - 15-84 r"1 r- 1 5. LEGAL DESCRIPTIO DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME NUMBER OFA EDROOMS SINGLE FAMILY ED One ❑ Four El Other ❑ TWO ❑ Five cit DATE DATE DATE INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY INSPECTOR INSPECTOR. INSPECTO MUNICIPALITY OF ANCHORAGE MUNICIPALITY OF ANCHORAGE OF HEALTH & ENVIRONMENTAL PROTECTION DEPT. OF HF;-.LTil 3 DEPARTMENT 825 LStreet- Anchorage, Alaska 99501 ENVIRONMENTAL PROTECTION • ENVIRONMENTAL SANITATION DIVISION -OCT 1 rj 1981 Telephone 264-4720 (('' '' ``'' REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE EI.NIISD DIRECTIONS: Complete all its on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTY OWNE ii PHONE ` -oa 7,Q MAILINGADD S D O PROPERTY ESIDENT (If different from above) PHONE 2. BUYER - PHONE MAILING ADDRESS 3. LENDING INSTITUTION yam V � r PHONE MAILING ADDRESS 4. REALTOR/AGENT PHONE MAILING ADDRESS - 5. LEGAL DESCRIPTIO STREET LO ION rG 6. TYPE OF RESIDENCE/ NUMBER OFA EDROOMS SINGLE FAMILY ED One ❑ Four El Other ❑ TWO ❑ Five ❑ MULTIPLE FAMILY Ea� Three ❑ Six 7. WATER SUP INDIVIDUAL* *ATTACH WELL LOG. Awell log is required for all wells drilled ❑ COMMUNITY since June 1975. For wells drilled prior to that date, give well ❑ PUBLIC UTILITY depth (attach log if available.) 8. SEWAGEDISPO AL SYSTEM INDIVIDUAL/ON-SITE** - YEAR ON-SITE SYSTEM WAS INSTALLED. ❑ PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. 72-010 (Rev. 6/79) 72-010 (Rev. 6/79) THIS SIDE FOR OFFICIAL USE ONLY - 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS - ❑ ONE ❑ THREE ❑ FIVE ❑ TWO ❑ FOUR ❑ SIX ❑ OTHER 2. WATER SUPPLY ❑ INDIVIDUAL ❑ COMMUNITY ❑ PUBLIC UTILITY Connection Verified PERMIT NUMBER DEPTH OF WELL DATE DRILLED LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM ❑INDIVIDUAL/ON -SITE El PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED INSTALLER ED SeTank or 71 Holding Tank Size: 000 If Tank is homemade give dimensions: SOILS RATING !/- ryC) TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL t_0 4. DISTANCES WELL T0: Septic/Holdinr� Tank Absorption Area Sewer Line earest L Not Line Absorption Area to nearest Lot Line 5. COMMENTS U,-�PPROVEDFOR �� BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY 72-010 (Rev. 6/79)