HomeMy WebLinkAboutGREENLAND BLK 5 LT 6 MO Un OF HA On-SiteCIPWater IT& WastewaterANCProgramORGE �� S• PO Box 196650 4700 Elmore Road Anchorage,Alaska 99519-6650 Phone.(907)343-7904 Fax:(907)343-7997 http://www.muni.org/onsite hcH On-Site Wastewater Disposal System Permit Permit Number: OSP171072 Effective Date: 5/5/2017 Work Type: SepticTank Upgrade Expiration Date: 5/5/2018 Tax Code Number: 01517131000 Site Legal Address: GREENLAND BLK 5 LT 6 G:2636 Site Mailing Address: 4600 E 115TH AVE, Anchorage Owner: TWOMEY JOHN Lot Size in Sq Ft: 17897 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field Q Septic Tank El 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 Received By. , 4 - 1 / Date: 57 // 7- Issued By: `e(�eA6-)ute-U� Date: 5/5 i 7 MUNICIPALITY OF ANCHORAGE i■ Community Development Department w Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water& Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 015-171-31 Property owner(s) John Twomey Day phone Mailing address P.O. Box 110437, Anchorage, AK 99511 Site address 4600 E. 115th Avenue Legal description (Sub'd., Block & Lot) Greenland, Block 5, Lot 6 Legal description (Township, Range & Section) Lot Size 17,897 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family (SF) ❑X (w/wo ADU) Septic Tank ❑Q Upgrade ❑x Duplex (D) ❑ Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE I WAIVER REQUEST FOR: Distance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. .140 (Signature of property owner or authorized agent) Permit/Rush Fees: Ai5 Waiver Fees: Date of Payment: 5-151 r' Date of Payment: Receipt Number: 3�1437 Receipt Number: Permit No. 05P( tLO? Waiver No. Permit App_ '___c Pannone Engineering Services ac Steven R. Pannone, Principal Registered Professional Engineer E-mail:steve@panengak.com May 3, 2017 Subject: Greenland, Block 5, Lot 6 Tank Replace Permit Request Design Narrative This is a design narrative for a permit to install an upgrade 1,000g septic tank to be issued for this property. The existing 1,000g is collapsing. It will be decommissioned per code and replaced. Currently the lot is developed. The proposed system will utilize a replacement 1,000g septic tank that will be connected to the existing drain field. The existing tank is located approximately 100'+ from the well. The proposed tank will be placed outside the existing well radius. All required separation distances will be met. 1. Upgrade Tank Design. A double clean out will be installed after the tank, and a foundation clean out installed before The tank will be located: 5'+ from any property line or building foundation 10'+from any water line 100'+ from any surface water 100'+ from any private wells 200'+ from any public wells The proposed installation will not affect the future development of the surrounding or existing lots. If you have any questions or concerns, please contact me at 907.272.8218. Sincerely, • • ! Steven R.Pannone IP •1s/,FESS;***t** Steven R. Pannone, P.E. Owner/Civil Engineer Mailing: P.O. Box 100217, Anchorage, AK 99510-0217 Physical: 332 East Manor, Anchorage, AK 99501 Telephone: (907) 272-8218 FAX: (907) 272-8211 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROI'ECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL. INSPECTION REPORT -NAME ,4' ,~ Y MAILING ~-D~'~I-SS ,~ LEGAL DESCRIPTION LOCATI ON DISTANCE TO: Manufacturer Liq, ~ ~a)lons IF HOMEMADE: DISTANCE TO: DISTANCE TO' We]l __.v. .__ LOo_: Width We]l Length Type of crib TO: Depth :,(/H 0 N E] [~NEW NO. OF BEDRO~,.~ No, of compartments~.. Inside length Width Liquid depth Dwelling PERMIT NO, Matedal gallons Nearestlotline /// PERMIT NO' 7¢<¢¢) '~;~ ?c~ .o .da,ion 2- Total leugtl Trench ti,,; ¢~ inches Depth Sewer line .L Septic ~aa~' Distance between lines Total effective~ area TNO. PERMIT NO. Absorption area(s) DISTANCE TO: Building foundation OTHER PIPE MATERIALS C: J /~1~¢"/~ ~ ~ SOILTESTRATING~ ~3 INSTALLER ~ . REMARKS A PP ~:p y . DATE LEGAL NAME 825 L Street- Anchorege, Alaska 99501 Telephone 2.64-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT 1PHONE ~-AI LIN G ADDRESS LEGAL DESCRIPTION, LOCATION We I · I Absor }tion area DISTANOETO:I /co S ' I S ~ Liq ca~ct~ nqa onsl ........ I Insidelength Manufacturer / ~' ~ Material NO. OF BEDROOMS ~ PERMITNO..~79~.) ~.~7,.~ No. of cornpa~.~nts Liquid dept h,~ PERMIT NO. g DISTANCE TO: .~_ Foundation ~ Nearest lot Ii,mtn_[ 0 No, of lines Length of ea~J~, Total length Trench width inches Top of tile to finish grade Material beneath tile Length Width Depth Type of crib Well PERMIT NO.7 ¢0¢¢ Distance betwee~ Ih]es Total effective ~bsT~t,~3 PERMIT NO. Total effective aPsorption area Depth DISTANCE TO: OTHER Driller Distance to lot line PERMIT NO. ~ Sewer line Absorption area(s) SOIL TEST RA% ~7 ~EMARK~_// APP~,~.V~ ED. ~ /"~ D,ATE Septic tank/ September 26, 1979 M.K. Matthews 3551 Admiralty Anchorage, Alaska 99502 Subject: Lot 6 Block 5 Greenland Subdivision Dear Mr. Matthews: It has come to the attention of this department that the sewer system on the above lot, which was originally represented to us to be within lot lines, has now been found to extend beyond lot lines into the street right-of-way and possibly into adjacent properties. Based upon these findings, this department will withhold approval until the exact boundaries are delineated by survey showing on--site sewer system and well locations, utility easements, etc. If the sewer system extends only into the street right- of-way, this department would not object to its location provided an encroachment waiver is obtained from governing agencies for the use of the right-of-way. A statement of no objection must be obtained from the owners of affected properties, specifically, Lot 15 Block 3 Homestead Hills Subdivision. The property is affected by protective radii from your sewer system if allowed in the right-of- way. Mr. Matthews Septen~er 26, 1979 Page Two If there are any further questions, please contact this office at 264-4720. Sincerely, Lynn J. Lindquist Principal Code Enforcement Officer pJL/ljw cc: Ken Nerman, Municipal Attorney PERM I 'l" DE~PFII~:tTHEt"~T 0t' dERLTH FIND ENV I ROI",IHEi1.'~TFIL. Dh.,..., TE.C:T Z I~iI~"~ E:25 '"L'" STP.'.'E, ET, FINCHORREiEL, FIK. '":,t'~ £ ... · .~,...., ... ':: '7S.~027'2 .':' FIF:'PL..'f CRNT LOC:FIT :[ ON LEGAL. I''1. K. 1'"IRTTHEI4S L ]: P'E,C O H E:& l:'L 7'T H, LT. 6 DL.I'C 5 GREEI'4L. frtND ~:55:t FtE:,H:[RFIL:[T'¢ Df;,'.. LO].' S ~l: ZE ::I. GOE~:: 5C.:E.~FIRE FEET '"'"""" ' "'" T"r'F'E CiE E;OZL. ~aE:S::R.E:TZCN z,'rz, lE1'1 .TS: TRE. 1.4UH ~ THE EEC.';IU:[RIED S.I:~.".E OF THE E;O];L FIB~;OF.!F:"f'.TCI1..,I S"r'S*f'EH ZS: "'~¢'"/~g~io ~¢ THE LENGTH [;:,IMEN.E;IO1.4 IS THE LENGTH (;IN FEET) OF THE TR. ENCM OR DRRII'.,IF'IEL. P. THE [:,EPTH OF R TRENC:H OR P]I" I5 THE D~STF:INCE BETPJEE1..,I THE St..IRFFICE OF"- THE EiI:E'~OUI'.4D RN[.':, THIE BOTTOM OF THE EXCRVFIT :I: ON THEP:'.E ~S NO SET !-4ZDTt-I FOR TRENCHES. ]''HE diRW,,,'EL E:,EPTt4 ):.S THE M.T1..1.TMUM E:,EF'TI'-I OF RND THE EJOTTOH OF THE E,'.',:C:F¢/FFI"ZON (::[I'4 FEE]".'.',. F'EI:~:i"I l T flF'PL. :[ CflNT t4flS 'tHE F.:ES.;PONS :[ E,' l L ]: TV ].'O ]: NFORH TH l :S E.',EF'RRTMENT I:)UI;;~ l NO THE :[NSTFILLFIT:[ON :[NSPECT:[ONS OF RN'¢ klEI.J....S PIE:0..TRE:EI'.,IT ].'O TH:[S PROPERTY FIN[;:, THE: NLII,'IBER OF' RES.f. DENCES THRT THE 1.4ELL 14]:LL SERVE. BI:::IIE:I..':.'E :[ L.L I NC:i OF RN°'r' SYSI"EH 1.4 DEF'RI~TI'4EN].' I.,.I.I:L.L BE SUBJECT TO I"iINIMLIH DISTF:INCE BETI4EE1..,I R 14ELL RND Ri'.,I'.? ON-~SI].'E SEP.IFIIBE D:[SPOSRL S'.r':.E,'rE:I"'I :I:S 2. OE~ FEET FOR F~ PRIVFITE I.,.tEI..L.~ OR :L50 "FO 200 FEE]' FROM F:l PUE',LIC NELL. DEF'ENDING UPON THE T"r'F'E OF:' F'LIE:L. ]: C: I.,.IEL. I .... OTHER RELqU I RE1."IENTS; FI"/R I L. FfiE:LE 1"O INSURE: Pf;.:OPE'Ir;.': I NSTRLLRT I ON. ]: C:ERT:[F¥ I'HFIT 1: I RH F'RH :1: L.. l FIR 1,4 :[ TH THF_' RE:'QL.I l I~EMENT% FOR C)N-~'.E;, l TE SEP.IER'S; FIN[':, .bJEL..L.5; FIE!; f::'OF.:TH E:~" THE 1.dLIN :[ E: :[ PRI...T T"r' OF:' FIIqCHOF.'.FIGE. ',;'~: :[ I,.IZLL :[NSTFtL!... THE S"~'STEM ]:N RCCORDFINCE I',IZTH THE CODE%. -7:: [ UN[::'ERSTRND ].'HRT THE ON*"S];TE :T,E!.4E:R S"r'STEM fdR"r' REr...:!UIRE ENLRi:~;:GE:HE1..,IT :[F' THE F::E'.:::;:[DENCE IS REMODELED TO T. NCLUDE HORE THF'IN .3: MUNICIPALITY OF ANCHORAGE DEPARTrvlENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 276-2221' SOILS LOG- PERCOLATION TEST SOILS LOG PERCOLATION TEST ASI No: 02679 PERFORMED FOR: 6-M Construcbion LEGAL OESCRIPTION: Lot 6, Block 57 Greenland Subdivision DATE PERFORMED: July 9, 1979 1 2 3 4 5 6 7 8 9 I0 11 12 13- 14.- 15- 16 17 18 19 2o COMMENTS --Organic Overburden 0.5' Silt w/Some Gravel (HL) Brown ~ 1.5' Silt w/ Tr. Gravel (ML) Gray S1. Moist T.Do SLOPE WAS GROUND WATER No ENCOUNTERED? 11,5' IF YES, AT WHAT DEPTH? SITE PLAN ~ppr?xi~at~ ~n_l.~z _~N_o~ _~_._ Zocated b sdrv~y deads. ' s ; 10' 0 P E 0~ Gross Net Depth to Net Reading Date Time Time Water Drop 1 7/9/79 10:27 0 min 5.53' 0.00' 2 7/9/79 10:42 15 min 5.56' 0.03' ~ 7/9/79 10:57 15 min 5.65' 0.09' 4 7/9/79 11:12 15 min 5.69' 0.04' 5 7/9/79 11:27 15 min 5.70' 0.01' PERCOLATION RATE 50 rain/inch (minutes/inch) TEST RUN BETWEEN 5,5 FT AND 11.5 FT PERFORMEDBY: Sieve Shrader CERTIFIED BY: er Alaska Soils Investigations 72-008 (7/76) DATE: July 9~ 1979 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION Pouch 6-650, Anchorage, Alaska 99502 ~'76-2221' SOILS LOG - PERCOLATION TEST SOILS LOG ~ PERCOLATION TEST ASI No: 02679 PERFORMED FOR: 6-~4 Construction LEGAL DESCRIPTION: Lot 6, Block 5, Greenland Subdivision DATE PERFORMED: July 5, 1979 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2O COMMENTS SiJt w/ Organics Brown Silt w/ Tr. Sand Ocn. 3" rook 1 .0I Gray SI. Hoist SLOPE SITE PLAN . ~ J TesL ~o1~ 10om~ion i~ , ~ ;,lodaLOd b',y ~ur~ey me~ns, i i 9.0' WAS GROUND WATER S : 1 0 ' ENCOUNTERED? NO L IF YES, AT WHAT E 0 I DEPTH? -- Gross Net Depth to Net Reading Date Time Time Water Drop 1 7/5/79 1:10 0 min 4.91' 0.00' 2 7/5/79 1:25 15 min 5.03' 0.12' 3 7/5/79 1:40 15 min 5.10' 0.07' 4 7/5/79 1:55 15 min 5.17' 0.07' 5 7/5/79 2:10 15 min 5.17' 0.00' PERCOLATION RATE 36 min/ineh (minutes/inch) TEST RUN BETWEEN 5 FT AND 9 FT PERFORMED BY: Steve Shrader CERTIFIED By~~ 8'~e~ Alaska Soils Investigations DATE: July 9~ 19_79 72-008 {7/76) ALASKA ENVIRONMENTAL CONTROL SERVIC , INC. 1200 West 33rd Avenue, Suite B ANCHORAGE, ALASKA 99503 (907) 56~..5040 SHEET NO OF CALCULATED BYr ~'~"~ DATE CHECKED BY DATE SCALE J ~/-20/- _ / ! PERMIT NO. [:,EPARTMENT OF NERLTH AN[) EN',,,'IRONHENTRL. PROTECTION 825 ."L." STREET., ANClYOF.:Af3E, AK. 264-4728 ~,..~ E L_ L._ F:~ E[ ~: I'¢'~ ~: "~' 790~50 ) FIPPL I CANT LOCIUlT ! ON LEGAl.. M.K. MFI'rTHEHS ii?TH AVE L.G B5 GREENLCqND S/D 355± FiDM I RRLT"r' L. OT SI ZE 'J..800~3 SqlJRRE FEET ftlNIMUM DI¢STANCE BE'FHEEN A HELL., AND RN"r' ON-'SITE SE:HAGE DISPOSAL. '.'5"r".:.?,TEI"~ 400 FEET FOF.'. R PRIVFITE HELL.: OR .'.1.,50 TO 208 FEET FROM A PUBLIC 1.4ELL DEPENDING UPON THE T"r'PE OF PUBLIC HEL. L.. HEL, L LOGS FIRE RE~;!UIRE[) AND MUST BE: RETURNED TO THE DEPARTMENT ~'.I~'t'HIN OF THE HELL COMPLETION. OTHER REQUIREMENTS f'lR¥ RPPL,'¢. SF'EC.T. FIC¢'~TIONS AND CONSTRUCTION [:'IRGRRMS AVAILRE:LE TO INSURE PROPER ~.NSTRLL. FITION. I E:ERTIF¥ TI-IRT :t: I FIM FFIf"I~L.T¢~R NITH THE REQUIREMENTS FOR ON-SITE SEHER% AND HELL:E; FI."5 SET FORTH B'¢ THE MUNICIPALITY' OF' ANCHORAGE. 2: I NILL INSTALL THE SYSTEM IN RCCORbRNE:E HITH THE CODES. V}i:. 2 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING ~/,,-¢' I 7 /,..~ / NAA# 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include 10t, block, subdivision, section, township, range) Location (addrEss or,directions) (b) Property ,owner Mailing Address Telephone: (home) Business (c) Lending Institution Mailing Address Telephone (d) Real Estate Company and Agent Address Telephone Mail the HAA to the following address: (or check here'~ if hold for pick up.) List contact person and day phone number below: (e) 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 th legality and status. 4. SEWAGE DISPOSAL On-site~l~ 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 ENGINEERING FIRM PROVIDING INSPECTIONS, TESTS, FILE SEARCH, DATA AND INFORMATION AS certified by my seal affixed hereto and as of the validation date shown beiow, l 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 /~'~-~' Telephone Address /F/~ .~/ ~'/~C/ ,~/'~.~/ ,~ Date /'~ 6. DHHS APPROVAL A p proved f~'r~Q~)bed room s by .~---~-~-~--~ ~u'-~;~-'- D a t e Approved ~ Disapproved Conditional Terms of Conditional Approval q:PJIi£'Ji 'The Municipality of Anchorage Department of Health and Human Services(DHHS) issues Healtll 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 DHHSdonotconductinspections 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. 72-025 (Rev. 7/88) Back Page 2 of 2 MUNICIPALITY OF ANCHORAGE (MOA) )'© ~,:¥.~1, ealth Authority Approval (HAA) :~ r.,~,j,~$11~HECK[.IST - FEBRUARY 1984 343 4744 A. WELL DATA Well Classification Well Lo9 Present,N) Total Depth ~'/~Cased to Static Water Level ~ Casing Height Above Ground Electrical Wiring in Conduit (~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) ~ .:- Date Completed '7'~7~ Yield Depth of Grouting Pump Set At ~ ¢~ Sanitary Seal on Casing(~7~N) Depression Around Wellhead (Y~) To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line /J/~ To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments J~ /~¢'/--¢-~ ; On Adjoining Lots / //-~ ; On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ;Date //¢~-'~' B. SEPTIC/HOLDING TANK DATA Date Installed ~/~-7?_Size Standpipes~N) _Air-tight Caps~N) Depression over Tank (Yh> Pumping/Maintenance Contact on File (Y/N) Holding Tank High-Water Alarm (Y/N) SFPARATION DISTANCES FROM SEPTIC/HOLDING TANK: / To wate¢-SupplY Well., To:ProPeity Line ~.~ To 'Water'Mai'n/Service Eine ~ No. of Compartments ~ Foundation Cleanout~N) . . ,/ ..... Date Last Pumped'':/~' -/2~ ~¢~ /~/¢~d-~ ?'/~/" Temporary Holding Tank Permit (Y/N) ~/~ To stream Popd. Lake:.Or Major Drainage Course To Building Foundation 'Fo Disposal Field '-~ Comments 72-026 (Rev. 7/88) Front Page 1 of 2 C, ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field --~ · Type of System Design Length of Field Depth of Field Gravel Bed Thickness Statndpipes Present(~tN) Date of Last Adequacy Test Square Feet of Absortion Area Depression over Field (Y~ Results of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: //5' To Water-Supply Well To Building Foundation Lot /J/~ / To Water Main/Service Line ./,¢ ~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments To Property Line To Existing or Abandoned System on ; On Adjoining Lots ~ To Cutback (if present) D. LIFT STATION ~alled l/ Dimensions Size in ~ ~,//~ Manhole/Access(Y/N) "Pump On" Lave at~'~"'~'~/~..~._,~ "Pump Off" Level at High Water Alarm Level at ~ Vent (Y/N) Tested for ~.~_ Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments **Check Permitted Bedroom Rating Against HAA Request** date of I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in the this ~,.... inspection. Signed Company Date MOA No. Receipt No. O ~'- ~- 0 ~"~/., Date of Payment / '~'- / -~ -"~"" F Amount: $ ,,/70' O0 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 e f.f,e,c Lo n '**/~7:~. En~¢s Seal 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 INFORiVIATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lo c ~tiO,~'~8 ~'~"~rj direct ion s) Institution [~; Ownor/BuiMer~'; Buyer ~: Other ~ (explain); (e) Real Estate Company and Agent Address Telephone (f) Mail the HAA to the following address: Telephone .... TYPE OF RESIDENCE Single-Family ~;[ Multi-Family [] Number of Bedrooms Other WATER SUPPLY Individual Well~ Community [] Public I~ Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAt. Onsite ~, Public [] Community [] Holding Tank [] Note: if community well system, must have written confirmation from the State Department of Environmental Conservation attestin9 to the legality and status. Page 1 of 2 72-o25n ENGINEERING FIRM PROVIDING ._,SPECTIONS, TESTS, FILE SEARCH, DA'f,..4ND 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 [~ . [~', Telephone ~/- ~-0~ ~ Date_ ~ ~ Approved,or ? - : beorooms ; Approved ,:,"/'~... Disapproved Conditional Terms of Conditional Approval CAUTION The Muncipality of Anchorage Department of Health and Environmental Protection (DHEP) issues Health Authority Approval certificates based solely upon the representations given in paragraph 5 above by an independent professional engin.eer 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 [)HEP 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 (~ i,,84) MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHORITY APPROVAL (HAA) CHECKLIST- FEBRUARY 1984 264-4720 Legal Description: ~-~:~-~- Well Log Present ~(,,/N) Total Depth %::' /" Static Water Level Casing Height Above Ground Electrical Wiring in Conduit (~N) Separation Distances from Well: To Septic/Holding Tank on Lot If A, B, C, D.E.C. Approved (Y/N) Cased to ¢~-~ ..~) Depth of Grouting ~9,~' ~' ........ Pump Set At 2, ¢ ¢ Sanitary Seal on Casing Depression Around Wellhead (Y/~ It0' p/vi ; On Adjoining Lots ! 6)0" ,ir..`- _ /L~'" / _; On Adjoining Lots ~//~//gr To Nearest Public Sewer To Nearest Sewer Service Line on Lot RT SF oTORY To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line Cleanout/Manhole Water Sample Collected by Water Sample Test Results _ Comments B. SEPTIC/HOLDING TANK DATA Date Installed _~-~. Size Standpipes (~)'N) Air-tight Caps Depression over Tank Pumping/Maintenance Contract on File (Y/N) Holding Tank High-Water Alarm (Y/N) .~. /.~ Separation Distances from Septic/Holding Tank: To Water, Supply Well j [0 / ' To Property Line .. ~.-O To water Maih/Se~i~e Line /CF course './o¢.~ "~"~ No. of Compartments Foundation Cleanout ~N) Date Last Pumped ~/~)/~ ~ ;for Temporary Holding Tank Permit (Y/N) /k/'/,Z:) To Building Foundation To Disposal Field ~', To Stream, Pond, Lake, or Major Drainage Comments Page 1 of 2-*,~:= C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ..~ t Square Feet of Absorption Area Depression over Field (Y,(~ Results of Last Adequi~cy Test Separation Distance from Absorption Field: 272. ' ..... Type of System Design Length of Field Depth of Field Gravel Bed Thickness Standpipes Present ON) Date of Last Adequacy Test Tt, 5 'roR y' To Water-Supply Well To Building Foundation Lot To Water Main/Service Line To Stream/Pond/Lake/or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area To Property Line To Existing or Abandoned System on ; On Adjoining Lots To Cutbank (if present) /~///~' lO0 2-0'4- Comments D. LIFT STATION Date Installed Dimensions ~ Size in Gallons Manhole/Access..(.Y/N~''''~'- "Pump On" Level at ~^ "Pum__.p-Of~' Level at High Water Alarm Level at ~,/.~..J Vent (Y/N) Tested for ' Pumping Cycles during Adequacy Test. Meets MOA Electrical Codes (Y/N) Comments ~ ** Check Permitted Bedroom Rating Against HAA Request ** I certify that I ,ha~ c/~k-~.d .~.erlf~1, °r c°nf°rmed t° all MOA and HAA guidelines in effect °n the date °f this inspecti°n' Signed QJZ.r Y Date ~)/[ ~./,~ ~ IF ' - I Company ~/~"'~ C..5~ ,/~/C, ~P~ -0 '~ t"/t' MOA No. Amount: $ ~* 0 0 Page 2 of 2 72-026 (11/84) ,F APPLI~ '~,NT FILLS OUT UPPER HA ONLY P;opertyOwner _ _. Phone Buyer Address Zip Code Lending Institution Phone Address Zip Code Realty Co. & Agent Phone Address Zip Code LegalDeseription ~'l ('~. !:~ l t:.i '2 ' k ,i ::-' :' / / 4-:,: / /.~// -:, /,, ::[ · Street Location /(') ,,/:): ' / Type pt Residence ~ Single Family [] Multiple Family No. of Bedrooms [] Other Wat?r Supply ~ Individual ATTACH WELL LOG. A well log is required for all wells drilled since June 1975. [] Community !ii r..;,~.[ For wells drilled prior to that date, give well depth (attach log if available). [] Public Utility _ . Sewer Disposal ~ Individual Year Individual Installed: [] Public Utility When Connected to Public Utility: [] Holding Tank NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. Time Time Time Time Date Date Date Date 9 ._.,,~ (~ .. Inspector Inspector Inspector Inspector Field Notes: /:J.-?/~ MUNICIPALITY OF ANCHORAGE ENVIRONMENTAL PROT:crION ( ) APPROVED BEDROOM8 'OONDITION8 OF APPROVAL ( 4~SAPPROVED ( ) CONDITIONAL APPROVAL' Soils Rating Date ~wer Installed Well To Absorption Area /'Z~N Well Log Received ( 72-023 (3182) 12, 1983 George ilerben, Pr'[sc:i.].].~ IR.?rben P. O, Sox J. 1~2106 Subjects l'.,ot 6, }}lock 5, (]~TeenJ. and Sub{ii. vi. sion Approval. JbF the J. ndfi. vidua], sewer and waLeu fac.i_J.J_t.ies cannot be ~ji:ani:ed until the ~io]J. owJ_ng :i. tems have [}eei] compJ, eted[ o 9?he sept:i.c tank pumped wJ. hh a ]fe(jo:i.?t subm.i, hted to this d epa ~.' l:me n t. adequate ac(.:oRl:[n9 Lo aat:J. Ol'la], St:and~uds, h J.J. sting oz pE:i. vate ~:i.E:ns peEfOU:~aJ.l~g tht} tost :i.s enoJ.osed. 'i'h:i.s heeds i:o bo submi, tted to th:i.s ofJi:i, ce for our rev:i_ew~ [lO/:ed (:l:i. sclfe[)anc.i, es have beell COEl:'ected. l~ hht~Ee aEo ~lly OR!7/e j/i~]2 l?,nc 1OS ~!re Jii. m Robertn Associ~l:e l::nviron.;:~en'i:.al Si2eciaj. i,si: MUNICIPALITY OF ANCHORAGE -' '~' ' ' Lr.]'tlkC)NMENIAL !-,;O t]CTION  DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 LStree,-Anchorage, Alaska 99501 SEP 2 0 t979 ENVIRONMENTAL ENGINEERING DIVISION Telephone 264-4720 R E C E i V E D REQUEST' FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FAOILITIE8 DIREOTIONB: Complete all pBrls on pbgc 1, Incomplete requests will not lie pro~essed, Please allow ten (10) days for processing, MAI LING ADDRESS PROPERTY RESIDENT (If different from abo~ PHONE 2, BUYER PHONE 3.MAtLINGLENDINGINSTITUTIoNADDRESS 4. REALTOR/AGENT J PHO~' MAILING ADDRESS 5. LEGAL DESCRIPTION STREET LOCATION 6. TYPE OF RESIDENCE '~ SINGLE FAMILY [] MULTIPLE FAMILY NUMBER OF BEDROOMS [] One E] Four [] Two [] Five J~ Three E] Six [] Other 7. WATER SUPPLY INDIVIDUAL* [] COMMUNITY [] PUBLIC UTI LI-I'Y ATTACH WELL LOG. A well Icg is reouired for all wells drilled since June 1975, For wells drilled prior to that date, give well depth (attach Icg if available.) 8, SEWAGE DISPOSAL SYSTEM "~ INDIVIDUAL/ON-SITE** [] PUBLIC UTILITY ~'lf individual/on-site, give installation date. $'~/~2'" /'/a~?,~ If system is over two (2) years old an adequacy test Is required by this Department. NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING CAN BE INITIATED. THIS SIDE FOR OFFICIAL USE ONLY DATE RECEIVED INSPECTION APPOINTMENTS TIME TIME TIME DATE DATE DATE INSPECTOR INSPECTOR INSPECTOR DIRECTIONS; 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX PERMIT NUMBER 2. WATER SUPPLY [] INDIVI DUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTILITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED I~ PUBLIC UTILITY Connection Verified INSTALLER [~]Septic Tank or []Holding Tank Size: If Tank is homemade SOILS RATING give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line I Nearest Lot Line I WELL TO: Absorption Area to nearest Lot Line 5, COMMENTS /APPROVED BEDROOMS [~ CONDITIONAL APPROVAL {letter must accompany certificate) [] DISAPPROVED DATE j O,/j (~/' ~ ~,'~ BY (Title) ~g,., ~ LEGAL DESCRIPTION 72-010 (Rev, 3/78) ALASKA B,,dlRO[lmeI1TAL CO[1TROL SGImolCGS, linC. ~nqin¢¢rin§ 6 ~nvironmmlal ~,lu~i~s JIM SMITtI PO BOX 111804 ANCHORAGE ALASKA 99511 SELLER-ZOLTAN G~AL JIM SMITIi PO BOX 111804 ANCHORAGE ALASKA 99511 8/22/86 60450 LEGAL:GREENLAND SUBDIVISION BLOCK 5 LOT 6 ADEQUACY TEST FOR SEWER SYSTEM ADEQUACY TEST DATE-8/]9/86 TIlE TYPE OF ABSORPTION SYSTEM IS A TRENCH WITH AN AREA OF ]272 SQFT. THE SYSTEM IS CAPABLE OF ACCEPTING 450 GALLONS OF WATER PER DAY. TItE SURGE CAPACITY OF TIlE SYSTEM IS 695 GALLONS. BASED UPON THE TEST DATA THE SYSTEM IS ACCEPTABLE FOR A 3 BEDROOM ItOME. SEPTIC TANK ADEQUACY TIlE EXISTING SEPTIC TANK VOLUME OF 1000 IS At)EQIJATE FOR THIS 3 BEDROOM HOUSE. THE SEPTIC TANK/FACKAGE PLANT WAS PUMPED ON 8/20/86 . THIS REPORT UOES NOT VERIFY THE INTEGRITY OF THE PIPING FOR TIlE WATER SUPPLY OR WASTEWATER SYSTEM. FI, OW TEST ON WELL WELL FI,OW I)ATE--8/]9/86 A ]fLOW TEST WAS PERFORMED ON THE WELL. 695 PUMPED AT A RATE OF 5.34 GPM OVER A DURATION OF THE DRAWDOWN WAS 2 ' WITH A RECOVERY TIME OF 2 AND TRE STATIC WATER LEVEL WAS 69.9 FEET, TIlE WELL IS ADEQUATE FOR TI{IS 3 BEDROOM IIOME. GALLONS OF WATER WAS 2 ItOIIRS. MINUTES 82_5 "1_" SI'REET ANCiIOI?AGE, AI_ASKA99501 (907) 264 4111 June 4, 1980 George Herben Box 10-2106 Anchorage, Alaska 99511 Subject: Lot 6 Block 5 Greenland Subdivision Dear Mr. Herben: IL appears as if the backfill over your septic system has settled to a point lower than the surface of the adjacent ground. This will cause the collection of water in the trench, which could lead to premature saturation of the absorption field and possibly the complete washout of the trench. would be advisable to refill the trench and tank area with four(4) to six(6) inches of earth as soon as possible. If there are any further questions, please call this office at 264-4720. Sincerely, Lynn J. Lindquist Principal Code Enforcement Officer i: ::A~NCHOI~G E;:' :ALAS~, 99518 ! ! DATE COLLECTmD NO~H I~Y . lc/ ~? , I.D. BO. (PUItlLIC'SYSTEMS) NAHE OF SYSTE[fl SYSTEM ADDRE~ TO,BE COI~LETED BY I~TER SUPPLIER TI. COLLECTED :] TYPE ~F SYSTEM AN 0 PUBLIC.INDIVIDUAL CIBCLE CLASS , A B C~~E?-'~ TELEPHONE NU -'~"I~Y STATE ZIP CODE 'L~ATION .HHE~E SAMPLE WAS COLLEC~ED ..... , COLLECTED BY:~{SIGNATURE TYPE OF SAMP '~E (CHECK ONLY O~NE THiS COLUMN) ~ DRINKIN~ MATER ~CH~CK TREA~ENT I-]CHLORINATED [~FILTERED ~3LUNTREAT£D OR,iOIHER r-1 RAW SOURqCE WATER r'l NEW CONSTRUCTION OR REPAIRS [] OTHER(Smecify) -~S THIS SAMP~IE A cHEcK SAMPLE TO A PREVIOUS NON-CONFORMINGiSAMPLE? 0 YES ~'INO PREVIOUS COLLECTION DATE ANALYSIS REQUESTED (IF OTHER THAN TOTAL COLIFORM) SEND REPORT ~:(PRINT FUlL NAME,ADDRESS AND ZIP CODE BACTERIO~O6ICAL WATER ANALYSIS RECORD FOR LAB USE ONLY OTHER FOR LAB USE ~LY RESUBMIT SAMPLE Sample rejected because: CHECK ONE OR ~ORE I'1 5am~le too long in transit. Sample should not be over 30 hours. [] Sample received too late in week ri Not in proper container rlLeAked out F'l Insufficient information provided. Please read instructions on form. [] Other (Specify) ANALYTICAL METHOD: ~"BRA"E FILTER ~ FE~ENTATZON TUBE Date & Ti~ Completed ~TORY RESULTS ~ Other Bacteria ~ Test unsuitable because: ~ Confluent Growth ~ T,TC ~TISFAC'r~Y ~/~ UWSATXSFACTORY [] Membrane Filter: Direct Count Verification: LTB Final Membrane Filter Results Reported By 0 BGB Date · Coliform/lOOml _Coliform/lOOml Time A.M. P.M. READ SAMPLE COLLECTION INSTRUCTIONS ON BACK OF FORH ~ LABORATORIES OF A .,~I<A. lNG C~:,AL. & gEOLOgiC, AL TELEPHONE ..... ~ ..... ' (~07) 279-4014 P.O. 8OX 4-1276 ANCHORAGE, ALASKA 9~ 4~9 BUSINE~PARK BLVD. '~ ~"-. ~ ,. ....... , Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER I,D. NO. Wat ~ m N~/''~ Mailing Addreaa City State Zip Code SAMPLE OA,E= Mo. Day ' Year SAMPLE TYPE: [] Routine [] Check Sample (for routine sample with lab ref. no. [] Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. 2 I LOCATION Time Collected Collected By TO BE COMPLETED BY LABORATORY LABORATORY: NAME CiTY Date Received Time Received Analytical Method: ~ Fermentation Tube ~ Membrane Filter Lab Ref. No. Result* , ,I ,E-FI ,. Analyst * No. el colonies 11130 mi. or NO, of PollSve porllonl. READ INSTRUCTIONS BEFORE COLLECTING SAMPLE Form No. 18-310 (3-78) 06-1220 (b} Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD · Date Collected Date R ,e, felved_ Presuml~t lye 24 Hours 48 Hours Confirmatory 24 Hours i 48 Hours ' Multiple Tube Report:__ Membrane FIIter: Direct Count Verlflcat Ion: LTD lOml Tubes PosltJvo/Total 1Omi Portlon~ · TELEPHONE (907) 562-2343 ANCHORAGE INDUSTRIAL CENTER 5633 B Street Drinking Water Analysis Report for Total Coliform Bacteria TO BE COMPLETED BY WATER SUPPLIER WATER SYSTEM: I,O, NO. Water S~/stem Name Phone No. City State MO. Day Year Zip Code SAMPLE TYPE: [] Routine [-~ Check Sample (for routine sample with lab ref. no. ['~ Special Purpose [] Treated Water [] Untreated Water SAMPLE NO. LOCATION ?.;".-/" )) L Time Collected Collecled By, ? TO BE COMPLETED BY LABORATORY ~alysis shows this Water SAMPLE to be: Y [] Unsatisfactory [] Sample too long in transit; sample should not be over 48 hours old at examination ' 'to'~indicate rb lab e i'esu ts. Please send new sample. Date Received Time Received Analytical Method: r~,~Fermentatlon Tube Membrane Filter Lab Ref, No, I Result* Analyst I *NO Of COlOn~es/10Oml or NO of Positive portions READ INSTRUCTIONS BEFORE COLLECTING SAMPLE 06-1220 (b) Rev. 1978 BACTERIOLOGICAL WATER ANALYSIS RECORD Date Collected Source Received Time Received Lab. NO. I 1Omi 1Omi 1Omi 1Omi 1.0ml OJ. ml Presumptive 1Omi I 24 Hours 46 Hours Confirmatory 24 Hours 48 Houri EMB Broth 24 houri= Multiple Tube Report= Membrane Filter= Direct Count Verification= LTB Final Membrane Filter Relult~ (. _.Broth 46 hours; , ZOml Tubes Positive/Total 1Omi Portions Collform/lOOml BGB Collform/lOOmi Tlme~ / ~, '~- , e.m.