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HomeMy WebLinkAboutWOODRIDGE BLK 2 LT 4 /zo/i1 N,0,AL,ry MUNICIPALITY OF ANCHORAGE On-Site Water& Wastewater Program . SO PO Box 196650 4700 Elmore Road . Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax:(907)343-7997 ,�v il, w http://www.muni.org/onsite r N. l)epartnicnt qh NOAA''' On-Site Wastewater Disposal System Permit Permit Number: OSP191272 Effective Date: 6/28/2019 Work Type: SepticTank Upgrade Expiration Date: 6/27/2020 Tax Code Number: 02009312000 Site Legal Address: WOODRIDGE BLK 2 LT 4 G:3337 Site Mailing Address: 16604 VIRGO AVE, Anchorage Owner: ZIDEK MICHAEL J & IRENE C Lot Size in Sq Ft: 47270 Design Engineer: ANDERSON CONSTRUCTION & ENGINEERING Total Bedrooms: 4 This permit is for the construction of: • ❑ Disposal Field II Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 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 Special Provisions: MOA mapping shows portions of the creek routing between the south property line and the 25 ft creek maintenance easement. The 100 ft separation between the septic tank and creek shall be confirmed prior to placing tank. A--- Received By: Date: 2 t u o() 1� Issued By: jalE,S2 Co Date: • MUNICIPALITY OF ANCHORAGE Development Services Department �f Phone: 907-343-7904 On-Site Water & Wastewater Section Fax: 907-343-7997 ON-SITE SEPTIC/WELL PERMIT APPLICATION Parcel I.D. 020-093-12 Property owner(s) MIK ZIDEIC Day phone Mailing address 16604 VIRGO AVE Site address SAME Legal description (Sub'd., Block & Lot) WOODRIDGE BLK 2 LT 4 Legal description (Township, Range & Section) Lot Size 47,270 Sq. Ft. Number of Bedrooms 4 567 ; APPLICATION IS FOR: APPLICATION IS AN: •'' • =k • LING: (®all that apply) v` Absorption Field ❑ Initial ❑ Q4' SI y\ t) Elx x ✓04/(`/wo DU) Septic Tank ❑ Upgrade ❑ a4 lex , y' ❑ r► p (Oy Holding Tank ❑ Renewal ❑ 4 p ultiple Dw- iri s ❑ Privy ❑ W6 SF 6 ) 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: t 360 Waiver Fees: Date of Payment: 6/9� � Date of Payment: Receipt Number: a,391-1 8 y Receipt Number: Permit No. OSP \'i\ a a Waiver No. G:IDevelopment Services\Building Safety\On Site Water and Wastewater\Forms\Client Forms\Permit Application.doc June 28,2019 Municipalities of Anchorage Departments of Health and Human Services P.O. Box 196650 Anchorage, Alaska 99519-6650 Fax 249-7847 �//JJ Re: New septic tank permit oM cv�,zrrVN �a�1 GC. W—r P(0 c r - en Y\ Legal: WOODRIDGE BLK 2 LT 4 To Whom it may concern: This is a request for a septic tank permit on the above referenced lot. This tank replacement will not impact any of the neighbors or encroach on any wells,septic or open water issues. Sincerer `�7.4. , Michael N. Anderson, P.E. 4661 Natrona Anch,Ak 99516 Ph 727-8864 k Ig 1.e° 0 2 P e,I i t----------------.:_oz_p':- 4 ,-.,1 \ ,' Il)&°1- 2/1j . II 1 N8/'356.Zo' G \ \\ ;\Ni O 9 1 `"\\\\\ ' /offt 4_ f <, t. 1 -.:' . , :I tvi %, '.....-- ---. `/ ' /la'p,ps R\ :_ --'L�.--- /'11 �� *iti '•ws. ,; 1 r\ \ \\\ , $ Septic Tank I \ \ ' ' r• J \ ` (aeon diff ' \ \ I t m , \ \ ., , - !/e// \ see dvlv:/ , I y o I !. \\ \ \ 1 • v \ \ J / a N , `A%p''r,.�.<!s /O GasS°y \ rare/ O I ... .t raye,4.,raa, /^;\ •1 \ 11 . �.. f9/P)04,...., 1 1 \ IJrirewy h I 1 0 r Duce//fish•_� // Lot I 9 a°9r SoILZO i- It, -74 ."+.:•? • ""a .' ', •. _ .. Amici - • - \ \^� 1( �\Li �.. :.q ce7'Q ?,, , 'c// i '� .. 17 —s • ,'r __ a — — - Ir� r_ •/ 1 \\ , Ufrea/ff-•.fear re,und"/ew 2SCree,,— - N38y'30l2.•E \� 1 387'/50"E °Fsfregq~ep� ' Ivay.58 OG E \\\,'� i4f.VJ' ') S83• / ! !� —�.- 5• r o ma__ — ab."7,t �� 1 -------------------------__:/ . ..7.41\1?•••• A •.C..xt � 0FAt ` E ! / */4.21.114, )°If ...* ,,, l • ( r 3r /. Gf l '- -• -- _ ••• £eserylnts of record,other than those shown on the 1 a t i•• MICHAEL N. ANDERSON . 4d Plot ore not shown hereon. \l J., ' : 9• i� 1 ' ry 'rei0/qq% pJp// �•• C .9/tb9 •� ¢N'by certify that I am properly registered and 3 57--02.,,, 1► _ 11..e.' � 7 /(!/ • f0\hce>ffsed to practice land surveying in the Stote of f ! F /t/lE 4e-, •• t`� ska and that this plot represents a survey made ) py/E/L/4/G 9 J ll pnfrSr5 4.\„. me or under my direct supervision and that all 7• ♦ nG . J .� distances and other details are c eat. a co . ..y• . • 2q 3rSAry . /oft a✓er/or , Signed //ua E • fVi•^ Y/.E� orerhony,ny. f • .,• deck -- 9 :j' 96y ASBUILT re-An:wn' wail, • d ca/B /'SIO' �_- „�,•, 3/io/9.=-- LOT 4, BLOCK 2 DET-A/4- W00DRIDGE SUBDIVISION, ANCH.,ALASKA '/" a a G LOCATED WITHIN �+� ice, SE 1/4 SEC.3,T.II N.,R.3W.,SM,AK. ---\..... ____ _____--,.._ _ R. L. FARMER a ASSOCIATES — 2502 W.43rd Court Anchorage,Alaska 99517 (907)243-6813 / N N / l \ / \ 1_ / -¢- Well \ / 25 Q \ALEI? 50 T51Xt 125 150 . . = 50F . \ / SWING rffa•;•' / 12fT• ,/ z. AO 30 • ••• • _---------- BD 1O 5 © t' r R?D CN I C p1h 7' / A :"............... 0 ellerR1�fA' rock 5 / ill° 44 t t 4 • g fofoJ length 5A' l.: ENCH r<GIRK 41 f / i?.........),.... .,,., SECO DARTS TEM 4 ;III lox .5 . \)Ii) 4i,,111 tf f , i � f 0 4 Jrc,ee -- ,:5;t/ \v/4-047 fit ♦ ' +� 491.h • t ral• . • • . •. • . • • . 4 4 tTji * ? TONSAAMO w ./ L... �♦ rj,`•. No. CE-2225 .•' � . • ; ; TOBBEN SPURKLAND P.E. LOT 5 1ILOOK 2 WOODRIDGE SEPTIC SYSTEM AS BUILT 203 W 15TH. AVENUE 16544 VIRGO AVE DATE: OCT. 14, 1996 ANCH. AK. 99501 g,RA ANO BRIAN SPINK SHEET: 2/3 GRID: 3337 .12.47.1.1.7.17...12.11--...—.----.—.—........ (~_~- '~ '. MUNICIPALITY OF ANCHORAGE  . DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchora§e, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT PHO~; [] UPGRADE 337 7~¥o ~EW -- NAME MAILING ADDRESS LEGAL DESCRIPTION ~ I - I LOCATION ~ ] ~7 0 Absorption arefl Liq. capacity i IF HOMEMADE: Well DISTANCE TO: Inside length Dwelling Well Eoundation DISTANCE TO: No. of lines Length of each line lines Top of tile to finish grade Material beneath tile Length Width Depth /-)-g [Dy~elling Width Material Nearest lot line Trench width NO.~./~BEDRpOM8 PERMIT NO. No. of compartments Liquid depth PERMIT NOt Liquid capacity in gallons Distance between lines Total effective absorption area PERMIT NO. Type of crib Crib diameter Well DISTANCE TO: DISTANCE TO: foundation Crib depth Total effective absorption area foundation Nearest lot line Driller Distance to lot line Sewer line Septic tank -"~. PERMIT NO. ~ ~0 ,~7 Absorption area(s) OTHER PIPE MATERIALS APPROVED 72-013 (Rev, 3/78) DATE LEGAL~of ~ T~IIM ~,~cO 8~c~3 SIX INCH WATER WELl_ DRILLED AND CASED OUT TO THE DEPTH OF ~20,~ DRILLED AT THE RATE OF ~ ~%00 PER FOOT. WELL LOG: 0 ..... 18' Coa.,~e PROPERTY OWNER ~ //PLge 2d_'x~-k- 4516 £ 9~h._ 99508 ~0~ 337-78~0 LOCATION OF WSLL S~TS ~. ~ ¢~-2, ~-~¢~F~ ~ ~, . ~ - ~ 0~/0 $o7,~ 46--205' B~Ao~. S~~. ~. Ro ~ ~ 4hoz~ ~ 726 ~ 1~ ~. 1/2 ~Pl& 164 ~ 172 ~ ~ a~¢ ~ ~ ~ ~o~ot~ ~o~ ~lo.z¢ ~ ~ o~ ~ Z~Z 1/2 ~Pfl ~ ~ ~;p¢ ~oc~ ~; 205 ~. g~ ~ ~ g ~ ~Ao~ ~ ~A ~ 150 ~ &o~. 1.6 ~o~ p~ ~ a~ ~ & ~¢. 0~ 250 ~ d~ r~z. g~z h~ ~ 30 ~ o~ 4~c¢~ MUNICJPALI~ OF AN~O~G~ ~ ~ ~0~ ~0~/~. DEPT. OF HEALTH & ENVIRONMENTAL PROTECflON RECEIVED Co,J~ o~ l)4.ZJ..b&q.: $23.00 pa~z ,Z,t. X 205 ¢~.: $4-715.00 DATE fft~ 204.A~ 1984 SERVICE CHARGEOF 1Y2% PER MONTH WILL BE ASSESSED ON PAST DUE ACCOUNTS. COST INCLUDES ALL LABOR AND MATERIAL FOR COMPLETION OF SAID DRILLING. WRITE CHECK PAYABLE TO RAMPART DRILLING WORKS FOR THE SUM OF ~4715.00 THANK YOU VERY MUCH. I I BERNIE CLAUS OF RAMPART DRILLING WORKS ., I'IUi'-.I ][ C: I F~FtI_ I T%-' F-IF: I=INCI~-IORIFtt]~ilS DEPFIRTMENT OF HEFILTH FIND ENVIRONMENTBL PROTECTION 8;25 L. STREET., BF,ICHORFIGE,, RK .~D50.1 264.-4720 ' ' PERMIT NO: DBTE 12;.StJED: 05?02?04 BPPLICRNT: .RDDRESS: CONTRCT F"HONE: HICHREL ZIDEK 45i6 E. TH. 9 TH RYE. RNCHORRGE¢ FIK ~D508 ~7--7840 LEGRL DESCRIP: LOT SIZE: I"IR~.~ BEDROOMS: SUBDIVISION: WOODRIDGE LOT: 4 SECTION: ]~ 'TOWNSHIP: .1.1N RRNGE: Z-'.W .l. 08FI (S~. FT. OR FICRES) 4 BLOCK: 2 LISTED BELOW FIRE THE OPTIONS k]VRIL. RBLE TEl YOU IN DESIGNING YOUR SEPTIC S¥STEI','I. CHOOSE THE OPTION THBT BE;ST FITS '.fOUR SITE. DEF'TH TO PIPE BOTf'OM (FT.) 4. GRRVEL, D[~PTH (FT.) 6. TOTFIL DEPTH (FT.) '1.0. GRRVEL WIDT4 ,,'FT. ', '"~ ,=..5 GRRVEL LENGTH (FT.) ~, GRRVEL VOLUME (CU. YDS. > "1.7. TRNK SIZE (GRLS) J.., 250. SOIL RI;TING (S(:,L FT, ./BR) 85 :+::+: TRNK HUST HFIVE RT LERS'F TWO CONPFIRTHENTS I CERTIF'¢ THRT: t. I AM 'FSI"IILIBR WITH THE REOUIRENENTS FOF..' ON-SITE SEWERS AND HELLS FtS SET FORTH B~r' THE NUNICIPRLITY OF BNCHORFIGE (MCR) RND THE STFITE OF RLRBKR. 2. I WILL INSTRL. L THE $'¢S'rEN IN RCCORDRNCE WITH FILL MOB CODES RND REt3ULRTIONS., RND IN COMPLIRNCE WITH THE DESIGN CRITEF.:IR OF THIS PERMIT, ]:. I WILL I~DHERE TO FILL NOFI BND STRTE OF RLRSKB REQUIREMENTS FOR THE SET DRCK DISTRNCES FROM BN'.r' EXISTING WELL., WFtSTIEHRTER DISPOSRL SYSTEM OR PUBLIC SEHERROE ':;¥S'f'EM ON THIS OR RI',IY RDJBCENT OR NEBRB'.r' LOT. 4. I UNDERSTRND THRT THIS PERMIT IS VRLID FOR R MFIXIMUN OF 4 BEDROOMS RNI} RN~r' ENLFtRGEMENT HILL RFOUIRE RN RDDITIONRL PERMIT. IF R LIFT S'FBTION IS INSTBLLED IN RN FIREFI COVERED B~' MOP] BUILDING CODES., THEN ('1) F~N ELECTRICRL PERMIT FIND INSPECTION MUST BE OBTFIINIED.~ (2) FIS-BUILTS WILL NO'T BE FIPPRO~?ED WITHOUT FIN ELECTRICFIL INSPECTION REPORT.~ RND (}.'., THE ELECTRICP]L I,.IORK I'IUST BE [.,ONE BY R LICENSED FLECTRICIFIN, SIGNED ~//~¢~6~/~// - - DBTE: ........... .......................... I}EF'F:IF~:'r'I',II!i]',IT [)F HEFIL..TH FiND Ei'.,I',/II:,U]$,IMEI'.I'f'I':IL J%i:OTECT~Cliq :3;i::5 L, STITEE'I", I'::Ii'.,IC:HOI:~:FIGE., FIK '..;.i1:9~]~121J.. F:IF'PL, I CFII',IT: I::'11} D I;;'.E :E; S: COI',ITFICT F:'HONE: HICI IFIEt. ,4-5:L[!S E. TI'I. :;2 TH I'::f,/E. FII",I C:I I O R F'l(:~i E. FII< L. EGFIL.. [)IESCR :1: P: :SL.IEJ[:, :[ ',,,' I :'_'i; I OI',I: I, IOO[:'R I I}GE L. OT SECTIOt",I: :~: TOHNZHIP: ::I.J.N I:;~'.F:INGE~:: 1.0T E; I ;~;.:I[Z: :L, I:~ll~',l::l (SQ. 1:::3". OR FICRES) II ,,., E:E[:,RooHz: 3 ~ I...]:S'HE]} IE',I~[~:'I..X]H I:::tRIE ]'I'IE OI::"FtOI",IS F'I',/FIZL, FI[~I_.E: ]'O '.r'(]lJZf',! [:,E:E;ZGNZNCJ 'T'OI, JR SEI:::'TZC :E;"/STE~:M. C:I'IOO:SE '1'1'1I~ OF'TIOIq "I'I"II::'IT BE:E;]" FITS './OIJR S:I:T'E. .... il'r' IF;;~;: lEE Ii'".[ C::: lb [ IEE: lEE: ~]',:" ~...-II :+::+: 'T'F:II",II::: MUST HFfv'IE FI]' L.t ....... I TI,.IO C(]MF'I::~R]'M[ii:NTS .................................. ? .............................................................................................. :t: CEI;U'I" ! ]:::'~T' "l't'll::l"l': ::1...:I: [::11"1' [::'I:::IH]:I..IFll;~'. I.'.I]:TFI TIlE I;;'.E'](i:!U:[I:'~:EMIE]",I'I",~i; F'OR ON-L:i; ]: TIE ::i:;E:].'.IE[;~',S I:::ll",ll} I-'.IEL. L,:~:; FIS SET I:::'ORTI'I D"J" "I'HE MI.,JIq]:C]:I:::'I:aLI"I"T' Cfi:: FII",ICHOI:;]'.FIGE (HOFI) FII',ID THE ZTFIt"E OF F:II..,,FI~;I':::FI, ';:::.I I',fI!.[. ]:N'ZTFtL,.L.. TI'lIE ',E;'T'ST[!i]"I i I",l I:::IC:COR[:'FII",ICIiE: I,,IITH FILL. HOFI CO[:'ES FII',I[:' RIFD]iUL..FIT'IOI",iS;, F:II",ID ]:~',1 COMI::'L]I:::II",IC!.'i: 14ITH 'I'HE [:'I'}:SZI]N CRIT['~]:;i'.II::I O1:::' THZZ F:'EF'.MII'. :ii:. I t.'.IIL.L FII}H!!!::FUX 'I"C[ F:IL, I.., I"IOFI F:II",ID '.'];TF:ITE OF:' FIL.i:::ISKF:I [:' :[ Z"FI:::INI]:i:i:S I::'F;UZ)H FIl",l"r' lei:':', :t: ::-:;'1" I I",IL3 I'.IEL.L .... i'.II::I:E;TEI,'.IF:ITEI:;i', [:':I: :i~F:'l:::l!'~l::l[.,. S'T':L'71"EH []IR F:'I_IBI,,. I C: ~!',[i:!.,.IEt';~'.F:IGE S"r':E;TEi]"I Ot",I "I'Mi:E; OR FII",I'T' F::IDJFIC[~:F,IT OR I",I[EFIi'~:B"F LCIT. 4. Z IJf',IDEITEi;TI:'iH[) "1'1'11::1'i' "I'H I :ii: i:::'Ei';.'.l'l I T ]: ~i; Vl:::ll._ :1: [:' FOR I':1 Hl::'l',q I HI...II"I OF ::~: DE[:,RI]OI"]!:5 I:~1",1[:' I:::ll",l"/ [ii:I',ILJ::IRI:'!ilEI"IENT I.,.IILL. RIE(;:]I..IIRE FIN I::'tD[)ZTICII",IlaL. _ .l.t,l.,ll' L.LM,. ~I:i",i FIN FIREFI L.L I,,.I.E£ E HOFI 131,,,lIL[)]:l'.,10i COE:,E:E;., 1]:::' .F:I. L.,IFT :~'I"]::ITIOI'.,I ]:$i; ......... : .... :: ';: ' " 'TFIIEI'.,I ,:: ::t. ::, F:IF,t EL. ECTR I CI::II,, t:::'1~i:1:;~:1'] I T Fli'.,lt:) I I'.,ISI:::'IZCT :1: Oi'.,I I','IL.I'.~;T [3E CIEiI'['I:] :[ I':,IE[:,.~ ,:: ;;~) Fi~!;-.-E~ll..1:1: L'T"}]; I,.IJ:LI.. NOT El:E: FIF:'I:::'I;;:OVE]}.~H:[T,~[OI..I'I'' F:lt'.,l E:I...EC]];i:[i}FII... !IqSF:'ECTIOi'.,I F:I!~:F'OF, U'.~ FII'.,I[) ,::]:) THE E:I..ECTF;:ICI:::IL. I.,.IORK t.:jl..l~t/li![l!i:.l~,Ol',ll'E E:'./.J~ L]:CEI.,tS~i:[)I~]..EC'I'I-;.iCII::IN. F:II::'F:'L.. I CF:II",IT: H ! [::l'll:::ll!i:' :;if: :1: [::,EK ' ": ...... :-' ' [:'F:I'HE PEI:;:I~t I T NO. E)EF'RRTMENT OF HEFILTPI FINE) EN',,,'IF']'.~I'"tENTFIL F:'F'OTE[:TIOI',I /~;,,~-~;-* ~' ,:..-,':' "'., : : .... ,: -. __ ,_,x .... '" L , I I~.EI_T., ~ I;1L. FIuB.~ bE., FtK. ':::~"~' I..-M E L_ b F~ F,I £) m: ~'-.1 -- S; I T' E 2S EE P411E IR F:" ~E F." P1 ]El'" FIF'PLIC:taNT MICHaEl_ ZIE:'EK 45:[,5 EFIST S'TH FIVE. LOCFITION ..... '- "' L tIT _, 1 ~ E L.E~SFIL. LOT 4 E,l~l.,. z !.,.IOO[:,RIE:~ISE :,ME,-~-\/ ~ ~_.~)C.~ :~ T'~'PE OF SOIL FIE:SOI;..'F'TION S'~.'STEP1 IS: T[~'.ENCH ,¢"~EIE~E~EI S~:!UFIRE F'EET I'"IR;,',',II'ILII'"I NUI"IBER OF' BEDROOMS = 4 SOIL RFITING (SQ FT/BR)= 85 THE RE6!UIRED SIZE OF THE SOIL FIE:SEIRPTION S"STEFI IS: B. [-: F' T' Pt := :l. ~.~) L_ E: Iq Ei T' Ma == ;2 '9 (ii ~. FI "...' E IL E:, ES P' ]" P~ == THE LENGTH DIMIENSION IS THE L. ENGTH <I~.,I FEET:) OF THE TRENC:H OF.: DRFIINFIELD. THE [)EPTH OF' [a TRENCH OR PIT IS THE DISTRNCE E:ET[,.I[:.'EN THE SURFFICE OF TFIE GROUN[:, RN[:, THE BOTTOM OF THE EXCRVRTION <IN FEET],. THERE tS NO SET [,.II[.',TH FOFI TRENCHES. THE GF.'RVEL DEPTH IS THE I'IINIFIUI'"I DEPTH OF' GRRVEL E:ET[,~E.:EN THE OUTFRLL PIPE RN[.', THE BOT'I'OI','I OF THE EXCR~,,'RTION ,.';IN FEET). PISRFI:[T RF'F'LICRNT HRS TFIE RESPONSIE:ILIT~¢ TO INFCIRI','I THIS [:,EF'FIRTNENT DURING THE II'4STFILLRTION IE;PEC:T:[ONS OF FIN'¢ [4ELLS RD.TRCENT TO THIS PROF'ERT"r' laND' THE f'4LIFIBER OP' RESIDENCES THRT THE [4ELL ['.IILL SER',,"E. [i:I:IC'.KFILI. ING OF Ft1"4'¢ SYSTEM [4ITHOUT FINRL INSPECTION RN[]' FHF'F'ROVFIL B'¢ THIS B'ISPI'-'IRTi"iENT 1.4IL. L BE ':]UB.ECT TO PROSEC:UTION. t'iINIMUI':1 DISTFINCE F~ETNEEN FI [4ELL RND ANY ON--SITE SIENFI(E DISPOSFIL SYSTEN I'-:; 'LL~(.;I FEET FOR R PRI',/'FITE I*IEL. L OR :b5~ ]"O 2E1E~ FEET FROM ¢~ PLIBLIC ~,.IELL [)EPEN[)II'Ei UPOI",I THE ]"'¢F'E CIF PUBLIC 1.4ELL. i"I]:NII:1LIN DIS'I't~NCE FROI'd R PRI'~,'RTE PELL TO R PRI',/FITE SB4ER LINE IS 25 FEET FINE:' TO FI C:OI':1NUNIT'¢ SEI.4ER LINE IS Z5 FEET. klELL LCIG5 IaRE REr;!IJIRED RND MUST DIE RETURNED TO THE I)EPFIFITMENT I,.lITHIr.,I 2:iii [;,R'T'S OF TPIE [4EI_.L COf,iPLETION. OTHER RE6lUIRENENTS NFI'¢ RPPL'¢. SPEC:IFIC:RTIONS FIND CONSTRUC:TION B,]:RGRRP'IS RRE R'¢RILFtBLE TO INSUFIE PROPER II'4STRL..LRT:[ON. F" ID: F,: f,,1 Z 'T" E~. ::< IF' Z F: IE L:; [:, E-' C; E i--'M E~ E F;-~. 2: :::L., :J_ S:¢ ."~. TS I CERTIF"r' TFIFIT :L: I ~::11"t FFII'{[LIRR I.'~ITFI THE RE~UIFIEi'"IENTS FOR Oi",I-'SITE SEI,-!ER:'5 FINE:' bELL. F:; FIS SET FOI~'.TH B'¢ THE I'"II..INICIPF'ILIT'¢ OF F¢'~CHOF.'.R(~E. 2: I I.'.IILL IN~TFILL THE. S'¢STEi"I IN RCCORDRNCE .t,.IITH I'HE (:.'O[:'ES 2:: I LINDEFISTFIND TFI.~:iT 'THE ON-SITE SE.~'EF.'. SYSTEM I'"IFI'¢ RE(;!UIRE ENLRF-'.CiEI"Ei",IT IF:' TPIE F:;.E; I [. Eli ]:E I S ,F¢:EI':1C~I)ELE[:' 1'0 IIf:LLI[)E I"IOR~ TFIFIN ,:!. bE[:'F.:OOI"IS. . S I, NEE):. Z .............. Fl' L I J21':i~T i"l I CFIFIEL~Z I E:,EK MUNICIPALITY OF ANCHORAGE DFPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, A~aska 99501 264-4720 SOILS LOG - PERCOLATIC)N TEST ~' SOILS LOG PERCOLATION TEST PERFORMED FOR: (~ '~ ,~l ~._ .~?-00 ~.~ DATE PERFORMED: 2 3- 5- 6 7 8 9 ---,10 11 12 13 14 15 16 17 18 19 2O (FEET) COMMENTS SLOPE SITE PLAN WAS GROUND WATER ENCOUNTERED? IP YES, AT WHAT DEPTH? Reading Date Gross Net Depth to Net Time Time Water Drop PERFORMED BY: PERCOLATION RATE TEST RUN BETWEEN CERTIFIED BY: (minutes/inch) FT AND FT 72-008 (6/79) 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 I.U.# (~O- C3°'l-~, \~ NAA# k'l~~'~('') \O(',~ 1. GENERAL INFORMATION Complete legal description Location (site address or directions) ' I¢'d'0 ¥ V, r'~,o AL~/¢, Property owner /'ff, l,~ ¢ ._7'r"e,,e ~:/¢t'eN Dayphone Mailing address I¢~'0~/ .V~r'~o ~.~ ~c4o~¢ ~ Lending agency ~' ~A '~ (¢~ ~'¢o Day phone Mailing address ~oo~ Cr~ ~ ~io~ D~;~.: ~c~, Agent N,/~, ~ ~ ~c4~ Day phone Address 2. NUMBER OF BEDROOMS: 3, TYPE OF WATER SUPPLY: Unless otherwise requested, HAA will be held for pickup. NOTE: Individual well ~'~ Community well Public water 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 v' 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 ~121 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 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 ~'/o~ ~-/-~,/ ~-¢cA.~/c~ [ ~¢,"u'~ ¢.~[ Phone 3' ~5-- 17¢-~ Address )~5-~0 Ec4o ~/./ ~C4or~, ~ ¢~5--1~ Engineer's signature ~~ ~ ~ Date 3/&~{¢~ DHHS SIGNATURE Approved for Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments By: ,4~/~~/~~. Date The Municipality of Anchorage Department of Health and Human Services (DHHS) issues Health Authority Approval Certificates based only upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHHS does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHHS do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 72~)25 (Rev. 1/91) Back MOA #21 Legal Description: A. WELL DATA Municipality of Anchorage Department of Health & Human Services HEALTH AUTHORITY APPROVAL CHECKLIST M ITY OF ANCEIORAGE ENVIRONMENTAL SERVICES DIVISION /~',,~( r', ~'~ S'(D Parcel I.D. Welltype Prw~¢ Log present(Y/N) Y Totaldepth ~ o~'-' Sanitary seal(Y/N) Date completed 5-/~_o/~ y Driller Cased to ~'! ¢' ' Casing height Wires properly protected (Y/N) REC F,[VED If A, B, or C, attach ADEC letter. ADEC water system number Date of test Static water level Well flow Pump level FROM WELL LOG AT INSPECTION 5'/ ~°/,¢¢' 3/ ;~o/ I'/ ' '~,5' g.p.m. 3,O C(n ~ 176~ ' SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot I0 8. ' Absorption field on lot Public sewer main Sewer service line g.p.m. ; On adjacent lots ~, ~oo ' ; On adjacent lots > ICc, _ Public sewer menhole/cleanout hh /~. Petroleum tank No~ ~ .~e,,^ WATEP. SAMPLE RESULTS: Coliform 0 cc~l {1~,o ~.~ Nitrate Date of sample: :~ { /'7 / ~ ~. Collected by: Other bacteria o col ~icc, m ~. El. SEPTIC/HOLDING TANK DATA Dete installed 5'/~-~ [ ~¢f'- Tank size Cleanouts (Y/N) Y '~'~' ' Foundation cleanout (Y/N) High water alar~ (Y./N)' FHA., Alarm tested (Y/N) Date of pumping ';' ~/~/"¢ / ~ Pumper SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK TO: Well(s) on lot I°g~ On'~.djacent lots To property line.,~,d"-~cr~, c.o. Absorption field Compartments Depression (Y/N) .~7_c ~ c.,. _Foundation Water main/service line N Surface water/drainage > f cc,' 72-026 (Rev. 7/91) Front CONTINUED ON BACK PAGE C. LIFT STATION N, Date installed Size in gallons Vent (Y/N) "Pump on' level at High water alarm level Meets MOA electrical codes (Y/N) SEPARATION DISTANCE FROM LIFT STATION TO: Well on lot D, ABSORPTION FIELD DATA Date installed ,'F { ~- I {~"/ Length 3 ? ' Width Total absorption area On adjacent lots Soil rating Depression over field (Y/N) IV Results (pass/fail) Do.o' Peroxide treatment (past 12 months) (Y/N) IVo,~¢ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Manufacturer Manhole/Access (Y/N) "Pump off" level at Cycles tested Surface water 85- c~/~'r~ Systemtype 5'~'~'¢ Gravel thickness 3. ~,' ' Total depth 7, Cleanouts present (Y/N) ¥ f Date of adequacy test ;~ / t,R /¢ for ty bedrooms /~',~ t,~,,v o ~C If yes, give date /~'/~. Wellon lot ~ To building foundation Onadjacentlots ~ ~o' Surface water Curtain drain On adjacent lots i> fcc/ Property line io' '/ To existing or abandoned system on lot N.A. Cutbank N, ,4. Water main/service line ;> ¢oc,' Driveway. parking/vehicle storage area 5" ' oGse~-v eeX. 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. Signature '~~ Engineer's Name Date I~ ~c ~ HAA Fee $ Date of Payment Receipt Number 72-026 [Rev. 3/91) Back MOA Ur ~q Waiver Fee: $ Date of Payment Receipt Number CHEMICAL & GEOLOGICAL LABORATORY A DIVISION OF COMMERCIAL TESTING & ENGINEERING CO. 5633 B STREET ANCHORAGE, ALASKA 99518 TELEPHONE (907) 562-2343 MfALY, I, P,E,O!,b~ for IIIVOIiE ~r $1950 FAX: (607) 561-5301 ?x~exYed ~dth Ordered ~y :T~P 1,100~g i,M~oic~to~y Supmv>.sor : 8TllPllgl'J 6, ~;DIi Sel~d I',opo:ct,q to; I)FI,A'FfOP D',(III}UCAL 3gV 2) 3532 JO Member Of the SG$ Gro.p (Soci~t(} G*n~rale de Serveillance) MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date GENERAL INFORMATION (a) Legal De~scription (include lot, block, subdivision, section, township, range) Location /address or directions) (b) Applicant Name /~//c'~"~-~-/--' ~'/~'"(' Telephone: Home 3¢~'~ ~'~/ Business Applicant Address ~/'~O~/' 'r/'/,'~¢ /'/Tbl~dl'J /'~' ~¢~'~'~ (c) Applicant is (check one): Lending Institution []; Owner/builder~; Buyer []; Other [] (explain); (d) Lending Institution Address Telephone (e) Real Estate Company and Agent ,), /,/' Address Telephone (f) Mail the HAA to the following address: 2. TYPE OF RESIDENCE Single-Family'' Multi-Family I'-I Other Number of Bedrooms ¢ WATER SUPPLY Individual Well~ Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environ mental Conservation attesting to the legality and statue. SEWAGE DISPOSAL Onsite~ Public [] Community I'"1 Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. Page 1 of 2 72-025 (11,84) ENGINEERING FIRM PROVIDING ~NSPECTIONS, TESTS, FILE SEARCH, DA'~, AND INFORMATION As certified by my seal affixed hereto and as of the validation date shown below, ~ 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. J 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 /~,--dy Telephone ~"'~/~'~ Address /~' ~ ~'~/ /~. 5'¢tl7~ ~, /~(~, ~ ~-~'~ Date /~ ~/-~ DHEP APPROVAL Approved for '/"~'" (¢) bedrooms by ~ ~' ~' /~"~ ApproYeO 1'~ Disapproved Conditional Cate Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) _ · ~ h~:)~°~iF~o.-~%cI\°~'' MUNICIPALITY OF ANCHORAGE (MOA) ~.,~',)~\C~.~,'~%~F.¥~ ' ~ HEALTH AUTHORITY APPROVAL (HAA) CH C US - ~¥~ ~ ~ 264-4720 WELL DATA Well Classification ~[~ If A B. C. D,E.C. A~proved (Y/N) __ Well Log Presen~N) Date Completed -~ ~ Yield Totel Depth _ ~ Cased to ~/ Depth of Grouting _ . Static Water Level ~O / Pump Set At ~/~ Casing Height Above Ground /¢~ / ~Y~ Sanitary Seal on Casing N) Electrical Wiring in Condui~N) Deoression Around Wellhead [Y~ Separation Distances from Well: / To Septic/Holding Tank on Lo~ /o~ ; On Ac.oining Lots To Nearest Edge of Absorption Field on Lot ~ /~ / : On Adjoining Lots To Nearest Public Sewer Line ~ To Nearest Public Sewer Cleanout/Manhole . ~ To Nearest Sewer Service Line on Lot Water Sample Collected by _~'.~ ~' ~/~ Date /~ ¢~¢~ Water Sample Test Results ~2¢~/ Comments SEPTIC/HOLDING TANK DA'FA Date Installed :~"/-.r ~ ¢ Size /~,,5'"0 No. of Comoartmems Standpipes CN) _ Air-tight Caps') Foundation Clea_~nou (Y~./) Depression over Tank (Y~ Date Last Pumped ~ W,~/ Pumping/Maintenance Contract on File (Y/N) -4,///pr, for Holding Tank High-Water Alarm (Y/N) _ /-)//'~' _ Ten'~)orary Holding Tank Permit (Y/N) _ Separation Distances from S6 ~tic/Holding Tank: To Water-Supply Well 1~3~ / To Building Foundation -.~'~ To Property Line ,/~:" To Disoosal Field ."~"~' To Water Main/Service Line .~'~) "/- To Stream, Pond, Lake, or Major Drainage Course ./¢o -'~ Page 1 of 2 72-026(rr/84) C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field Square Feet of Absorption Area Depression over Field Results of Last Adequacy Test Separation Distance from Absorption Field: To Water-Supply Well To Building Foundation Lot ///~ To Water Main/Service Line /07 / To Stream/Pond/Lake/or Major Drainage Course Type of System Design Length of Field Depth of Field Gravel Bed Thickness -'~' ~'~ Standpipes Present (~N) Date of Last Adequacy Test To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) ,'¢'/,~ /~/ ¢- To Driveway, Parking Area, or Vehicle Storage Area Comments ~ LIFT STATION ,/..J,,/. Dimensions "Pump On' Level at '~---.. ~ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for Electrical Codes (Y/N) Comments during Adequacy Test, Meets MOA Receipt No. Date of Payment Amount: $ ** Check Permitted Bedroom Rating Against HAA Request ** ~'"'"-* - I certify that I havecheC~ed; ve,C...fied, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed ~"~.~-----~/ /-C/'/~ Date / Company ,/~(-~' MOA No. ~ "~'~/ Page 2 of 2 72-026 (I 1/84) ALASKA ENVIRONMENTAL CONTROL SERVIC ', INC. 1200 west 33rd Avenu=, Suite B ANCFIORAGE, ALASKA 99503 (907) 561.5040 ,/