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HomeMy WebLinkAboutSILVER CREST BLK 1 LT 4ASilver Crest Lot 4A Block 1 #015-062-59 Municipality of Anchorage Page 1 of3_ DEPARTMENT OF HEALTH AND HUMAN SERVICES ENVIRONMENTAL SERVICES DIVISION P.O. Box 196650 Anchorage, Alaska 99519-6650 Telephone: 343-4744 On -Site Wastewater Disposal System and/or Well Inspection Report Permit Number: SWOOO190 PID Number: 015-062-59 Name: TOM AND SUE SENTER wastewater System: ■ New ❑ Upgrade Y P9 Address: GROVER ST ABSORPTION FIELD Phone: No. of Bedrooms: (907) 346-3278 55 ■ Deep Trench 0 Shallow Trench 0 Bed 0 Mound 11 Other LEGAL DESCRIPTION S.11 Rating: 1.2 Total Depth from artghml grade: 9.2' CPO/Sq. FL - 10.0' Ft. Lot: Block: Subdivision: Depth to pipe bottom from original grade: Gravel depth beneath pips 4A 1 SILVER CREST 2.2' — 3.0' 6.96' Ft. R, Township: Range: Section: pill added above original grade: Gravel length: — — — 0' — 11 Ft, 45' Ft. WELL: ❑ New ❑ Upgrade Gravel width: 2' Number of linen: 1 Dietanm between lines: — pe, Ft. Claswhcatka (Private, A8,C): Total De Cowed To:prpe Total ohne pt an oma. P N Ft. Ft. 625 50. ft. ASTM DI: -3034/F-810, Driller. Date Untied: stwIc Water Level: Installer. DENALI SEWER & DRAIN I Date huddled: 7/7/2000 SCHED 40 YNd:Pump set At: Casing Haight Move Ground: TANK GPM Ft. FL SEPARATION DISTANCES 0 septic 0 Holding ■ S.T.E.P. To Septic Tank Absor tion Fled Lift Station Holding Tank Publle/Private sewer uvea Manufactamr: ANCHORAGE TANK copoaity In gallans: 2000 From Well 100'+ 100'+ — — 25'+ Material: STEEL Number at compartments: 2 sort°ae Water loo'+ 100'+ - - - LIFT STATION Lotsae 5'+ 10'+ — — — in gallons: Manufactumr. Line 2000 ANCHORAGE TANK Foundation 5'+ 10'+ 'Pump en- level ah -Pump off, Isom of: Hlgh water alarm m: — — — 39" 139 45" Curtain Drain NONE KNOWN Pump Make & Model: #20 OSI 05 HHF eecmcal Inspections performed or. M.O.A. Remarks: BENCH MARK Location and Dewrlp8on: \'_ .s NORTHEAST CORNER OF CEMENT SLAB BY MAN -DOOR IN FRONT OF HOUSE. Meumed aaratlan: 100.00 Ft. ENGIME R8 W -AL o�� p Inspections performed by: AWWC, INC. Dates: 1st 6/30/2000 2nd 7/5/2000 0....c :... 3rd 7/7/2000 ...... ....... Q fre A. esS; �ppad Department of Health and Human Services approval —7953: •' 4` ' / �iDate: Reviewed and approved by: /n/, - o�4p°dA c�FcdO ro loo f as 00 DOOD�p�oo 72-013 (Ray. 0/911 MOA 25 PERMIT NUMBER: SW0OO19O EXISTING DRAINFIELD CONNECT SECOND TANK. OUTLET AS -BUILT DRAWING PO15L ID N 062- 59R \ A B Sit 24.6 12.9 ST2 33.0 22.1 MHL 35.4 24.7 DVI 36.7 26.6 DV2 CO 37.2 25.3 26.6 29.7 MTI 51.4 32.4 Mrz a7.o 7D.1 \ hTT2 \ \ Co DVI //j/ /7 DV2 MT RESERVE SITE P / n \ NEW DRAINFILED / �\ NEW 2000 GALLON / S.T.E.P. TANK WITH DIVERTER VALVES. l � 7/1 ALASKA WATER & WASTEWATER SGALE too" r• �ul -M. CONSULTANTS, INC �� �-v� „ 44 .. ...... 701 DEIIARR ROAD. SUITE 2R • ANCHORAGE. AK 99504 • PHONE (907)357.6179 • FAX (907)3383246 1 = 4D ,PARED FOR: PHONE NUMBER: TOM AND SUE SANTER (907) 346-3278 IAL DESCRIPTION: SILVER CREST SUBDIVISION; LOT 4A, BLOCK 1 E OF WORK: AS—BUILT OF SEPTIC SYSTEM UPGRADE. 1 OF 1 uo f 79 • C 7953 m� \ vat R -72-z-7 6 O D TO/ \ \ \ hTT2 \ \ Co DVI //j/ /7 DV2 MT RESERVE SITE P / n \ NEW DRAINFILED / �\ NEW 2000 GALLON / S.T.E.P. TANK WITH DIVERTER VALVES. l � 7/1 ALASKA WATER & WASTEWATER SGALE too" r• �ul -M. CONSULTANTS, INC �� �-v� „ 44 .. ...... 701 DEIIARR ROAD. SUITE 2R • ANCHORAGE. AK 99504 • PHONE (907)357.6179 • FAX (907)3383246 1 = 4D ,PARED FOR: PHONE NUMBER: TOM AND SUE SANTER (907) 346-3278 IAL DESCRIPTION: SILVER CREST SUBDIVISION; LOT 4A, BLOCK 1 E OF WORK: AS—BUILT OF SEPTIC SYSTEM UPGRADE. 1 OF 1 uo f 79 • C 7953 m� \ PERMIT NUMBER: AS -BUILT DRAWING PARCEL ID NUMBER; SW0001go 90 _ 015-062-59 FIWL CWP -102,54'- 10257' 5TI 512 MN fOP Or MW—" TOP or MIK Ai'I\a T -96b6'\ / AYa=T-96.61' Mvwrcr( M- AT l W - 96,09' NSW 2000 GALLON 5ftP. TANK M161VL Gwc P 105.23' - _ mRr O7 61RJG Af am,fr - 95.91' Mf FiM 6QAM •=105,95' -106.56' 1 I1 wOr"PrP- 102,99 1.25" PVC WITH 0.25" Ha i!5 MIN 2 FW, 00rfOM Or mWH 96.03' DATE: 7/24/200 „T DRAWN BY: ALASKA WATER & WASTEWATER i'W'M' �` r CONSULTANTSINC. ,n,,, •��.,w-�:. -...,Esti SCkLE: , 701 DEBARK ROAD SUITE EB •ANCHORAGE AX 99604 •PHONE (907)337-6179 •FAX 907 fi6B3246 1 = 30 :..... ... ........... -PARED FOR: PHONE NUMBER: PACE NUMBER: Q TOM AND SUE SANTER (907) 346-3278 1 OF 1 Q e re A. orne s.-' ;AL DESCRIPTION: QO —79$ i SILVER CREST SUBDIVISION; LOT 4A, BLOCK 1 �Q s E OF WORK:G 0 4F'co PROFILE AS -BUILT FOR SEPTIC SYSTEM UPGRADE Q Orofessil 400;00 'FROM : Denali Sewer & Drain y y PHONE NO. : 907 333 9776 Aug. 29 2000 03:a03PM P1j • AUG. +J. COOV� �:�7P5 ALIH;� tLWY 1r1 a �II NO F.SYF�a.r; M4 .NWMCEALiTY OF ANCBMAG$ — WELDING $AFE1"Y DIVISSaN raw salrraHs A"W eMW ANaMMAG19 AT.AM rn�W�scnrons�yoar � �M � � 3�.ttis . �suaan: pi7/ �Jl ' XAM& ALCA21i884W2 A 9°W GROMmh 4A SUAWMMI SILVEt'EST 7M OP 111 111�A01[17• $Voplio�lo� Iaeaesseyinaabnw3 Q 000NPor ❑ CQORmwd ❑ wiammImisrata"hupo" r3bo p CJM0. *X 40=MMbe dNo Rdogrre4osv4 O fJ,ELr0-lCAi- U00MCW94VNb &FtNar[.. waR ��.PYtC. Ur -Y srrar'110N A+?P-0V,0 RECEIVED AUG 30 2000 Municipality of Anchorage Dept. Health & Human Services . I--4jzYx A/ BA9s. —1 — 140 jV"MCNM5 ,970lWA11i1ALlAa, NAM C011illrORHMJiMN i�f► • DQ:N.O1.'.�Bllni�!±iiil�91Y091r.�' Soot xmvs 9t1I6uas FT80 CYC 400 RYd BC:TI o0a6/6d/P MUNICIPALITY OF ANCHORAGE Department of Health and Human Services On -Site Services Program 825 L Street, Room 502 P.O. Box 196650, Anchorage, AK 99519-6650 (907) 343-4744 ON-SITE WASTEWATER DISPOSAL SYSTEM PERMIT C)C C�LYLL Upgrade Da a Issued: Jun 23, 2000 Permit Number: SW00019D Legal Description: SILVER CREST BLK 1 LT 4A Design Engineer: 0041 AK Water & Wastewater Consultant Owner Name: Tom & Sue Senter Owner Address: 9340 Grover St. Anchorage , AK 99516 - Expiration Date: Jun 23, 2001 Parcel ID: 015-062-59 Site Address: 009340 GROVER DR Lot Size: 47359 SQ. FT. Total Bedrooms: 5 Permit Bedrooms: 5 This permit is for the construction of: K Disposal Field 0 Septic Tank Holding Tank ❑ Privy Private Well Water Storage All construction must be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations ( 18AAC72 ) and Drinking Water Regulations ( 18AAC80 ). 3. The engineer must notify DHHS at least 2 hours prior to each inspection. Provide notification by calling (907) 343-4744 ( 24 hours ). ( Not required for a Water Supply Permit only ). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather must be either: A. Open and closed on the same day. B. Covered, /sealed, and heated to prevent freezing. Njx ,- -t&l y bN ly A"rkvt: /U' SLrpy r...fr o.�, Tra.x 0 Q t'th "t rn sfca Received By: Issued By: Date: 6'� on Date: — 23 ,A? ALASKA WATER Ze WASTEWATER '=-, -a CONSULTANTS, INC. e _ _-- June 21, 2000 Municipality of Anchorage Department of Health & Human Services Division of Environmental Services On -Site Services Section P.O. Box 196650 Anchorage, Alaska 99519-6650 Ref: Well and Septic Design for Lot 4A, Block 1, Silvercrest Subdivision To whom it may concern: The existing 5 bedroom house is served by a private well and septic system. The septic system on the lot is in a state of failure and needs to be upgraded. A test hole was excavated on the property. The proposed septic system will be designed around the 30 foot radius of test hole #1. We are proposing that a 2000 gallon S.T.E.P. tank and a trench type drainfield be installed. Comments regarding the proposed design are summarized as follows: 1. SOILS: Attached is a soil log which shows the soil classifications, groundwater monitoring, and the percolation test results. The soils below the organic layers are a SM material to a depth of 4 feet followed by moderate variations of SP and SP/SM soils to a depth of 17 feet (bottom of test holes). No groundwater was encountered during the excavation of the test holes. A percolation test was performed between the depth of 7.0 feet and 7.5 feet which had a percolation rate of <1 minute/inch. It is our opinion that the insitu soils will serve as a sand filter. 2. TRENCH DESIGN: a. Percolation Rate: <l minutes/inch b. Allowable Application Rate: 1.2 gallons/day/ft2 c. Number of Bedrooms: 5 d. Design Flow: 750 gallons per day e. Minimum Absorption Area: 625 ft2 f. Total Depth: 11 feet (max.) g. Effective Depth: 7 feet h. Width: 2'+ feet i. Minimum Length: 45 feet long j Effective absorption area= 630 ft2 6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246 — akwwacom 3. SURFACE WATERS: There are no surface waters within 100 feet of the proposed upgrade. 4. TOPOGRAPHY: As can be seen on the attached topography site plan, there is a slight hill that runs perpindicular to the proposed trench. The trench is to be installed parallel to this slope contour. We are unaware of any adverse impacts this installation would have on adjacent wells or septic systems. If you have an questions, please contact us at 337-6179, or 244-9612. Thank you for your assistance. P.E., M.S. NOTE .• Attached is a site plan drawing, a design drawing, a topography site plan, soils log, and a 7 page construction specification letter which are all part of the design package for this septic system. 6901 Debarr Road, Suite 2B — Anchorage, AK 99504 — Ph: (907)337-6179 — Fax: (907)338-3246 — akwwacom J IMIT CIRCLE LOT 3, BLOCK 2 SILVER CREST L LOT 9, BLOCK 2 SILVER CREW LOT 6, BLOCK 1 SILVER CREST LOT B. BLOCK 1 SILVER CREST / t LOT 5, BLOCK i 1 SILVER CREST 1 I �o� 1 yob 1 1 I t, \�\♦ \ , LOT 9, BLOCK 1 SILVER CREST v � I e 1 -- �� � � 1 i t sysrEle u / U t a tt LOT 3E B SILVER ORE LOT B, BLOCK 2 SILVER CREST �HNG SEPTIC SYSTEM. ` s� n LOT 10, BLOCK 2 �\ SILVER CREST LOT 2A NEITLETON ACRES #3 I 1 t I / LOT 3A, BLOCK 1 SILVER CREST .:_DRAWN BY: U \�C!••••... latl� ALASKA WATER &WASTEWATER �.w.m. `�� :. .S.T %" �. CONSULTANTS, INC. SCALE: 1 n = loo, ,� ; - 6901 DEBARR ROAD SUITE 28 • ANCHORAGE AK 99604 • PHONE (907)337-6170 • FAX 907 83246 ..... REPARED FOR PHONE NUMBER: PACE NUMBER: TOM AND SUE SANTER (907) 346-3278 1 OF 1 f e G esS. 7953'`ca` ECAL DESCRIPTION: SILVER CREST SUBDIVISION; LOT 4A, BLOCK 1 S^@r.• 'r SITE PLAN I. F� EXISTING DRAINFIELD. INSTALL CO & ! i AT END OF TR NG r : EXISTING UNDOCUMENTED DRAINFIELD. / SUMP LOCATION IS KNOWN BUT ACTUAL a.:. ROUTE OF LINE IN UNKNOWN. ABANDON IN PLACE FOR POSSIBLE FUTURE USE. L' .P:•." PROPOSED DRAINFIELD. EXCAVATE A TRENCH THAT IS it FEE DEEP (MAXIMUM), BY 2 FEET WIDE, BY 45 FEET LONG. /j ADD 7 FEE OF CLEAN WASHED SEWER DRAIN ROCK. / \ Ro N�o -5 BEDROOM RESERVE SITE PROPOSED NEW 2000 GALLON 11/ S.T.E.P. TANK WITH DUAL OUTLETS. / / / / s � J.W.M. ALASKA WATER & WASTEWATER SCALE: oo�*ip �*I CONSULTANTS INC _. 1„ = 40, �...... ..... �. ,a ,,,,. ,,,.. TOM AND SUE SANTER 907 346-3278 1 OF 1 % O t�z;'Q," f •*A. Gamess,.4L DESCRIPTION: Q -7953SILVER CREST SUBDIVISION; LOT 4A, BLOCK 1 ''•, "amOF WORK: r, essiot`oYDESIGN DRAWING FOR SEPTIC SYSTEM UPGRADE. OO000��� ALASKA WATER & WASTEWATER CONSULTANTS, INC. 6901PHONEARR (90) 337 —5179 SUFrE 29 FAX (903 ANCHORAGE, 9504 324fi SOIL LOG - PERCOLATION TEST LEGAL DESCRIPTION: SILVERCREST S/D; LOT 4A. BLOCK 1 PERFORMED FOR: TOM AND SUE SENTER DATE PERFORMED: 6/16/00 DEPT ORGANICS TEST HOLE #1 (f PT 1 DEPTH TO GROUNDWATER DATE '.0 •'! 6/16/00 DRY CLASSIFICATIONS K X51 r� 6/22/00 9—TIONS S rxt EISOIL SI I • . x Vsm . IIIIIIIIIML y • . Ii�lll!11GMr///%CL N 14 15 • � rxl Z S MH4k� . ,,CH • fYib.� SC DEPTH TO GROUNDWATER DATE '.0 •'! 6/16/00 DRY 6/20/00 K X51 r� 6/22/00 9—TIONS S rxt VARIA OF SI x SOIL ABSORBED WATER AS FAST AS IT WAS ADDED. i WEEP y • . ts� 14 15 I � rxl Z . DEPTH TO GROUNDWATER DATE DRY 6/16/00 DRY 6/20/00 DRY 6/22/00 f y A. Garness: E-7953 FG dProfessio�o\ri DATE READING CLOCK TIME NET TIME WATER LEVEL NET DROP (MINUTES) READING (INCHES) 6/16/00 TEST RUN BETWEEN 7.0 FT. AND 7.5 FT. SOIL ABSORBED WATER AS FAST AS IT WAS ADDED. PERCOLATION RATE <1 (MIN./INCH) PERC. HOLE DIA. 6 (INCHES) TEST RUN BETWEEN 7.0 FT. AND 7.5 FT. PERFORMED BY ALASKA WATER & WASTEWATER. I, JEFFREY A. GARNESS, CERTIFY THAT THIS WAS PE FR D IN ACCORDANCE WITH ALL STATE AND MUNICIPAL GUIDELINES IN EFFECT ON DATE: Do ^s� �� "f &eArriDoo s LOVITT CIRCLE LOT 3, BLOCK 2 SILVER CREST LO BLOCK 2 SILVER CREST -LOT"9;B OC 2 SILVE RE LOT 6, SL 1 �p SILVER CRE Qo LOT 5, BLOCK 1 EXISTIN EP E SILVER CREST �p OT 10 K2'QP L O FP �2 LOT 8, BLOCK 1 SILVER CREST 100' WELL RAOIUS LOT 9, BLOCK 1 SILVER CREST LOT 3B, BLOCK 1 }I Vy SILVER CREST LOT 3A, BLOCK SILVER C L N RES 3 J� G� J\5k. �o ATE: 6/21/2 DRAWN BY: K.D.W. SCALE: 1 " - 100' 9D1 DEBAR ROAD, SUITE 2B • ANCHO BE. AH 950 • HO (90 33 179 PX (907)3 -3246 PR ARED R PH NE NU B R: PAGE NUMBER: NTE (9 7 346 3278 1 OF 1 LEGALSCRIPTI N: SIL ER C EST SUBDI ISI N; L T 4A, B C 1 TYPE OF WORK: POGRAP ICAL DRA IN MUNICIPALP.PY 01' ANCHOPACE II h and Environment --al Prot ton Four [ --h Ploor wc:0: 825 1 S t-rec L Anchorage, Alaska 99501. 264-- 4720 �jk), Ii j j i,; . All 11\151"c'CITION RiTC)PI ()M-Sh'� MA'VAC�: AF)IML55.88(r) r--. Woor� Loop_ I'l ION! LOC A I I ul It- t ;:Il I cyl I ON Le,7- 7-, SF PF I C IAN K: [A 1 1. 1 n f 4 (:1 -0� f -11 A I d U I AC I U R L PG 1 At., 1"6 4 f1m,11111FR OF F ROM V/� I - L �V :j i L I r I G I I I I N51 I ) (, .-PW - I MUM Df 1,1001f) CAPACI I­Y--4GALLONS. TIL[ DRAIN Fli LD: L 1' 0 1' /1, 1- 1. Lf GTN .3 UI riLARFID I t 0 1 tjNr --OF I ME t !-f � 0 M L L V�-() FOUNDA I ION if of 1, mes DISI AHCI- UU-1 WELN I IN[ I I 11. M C I I VV I U r F I YT ;N. TWA[, C--i-FF--C-fJVE [-(-N(; I I i Uh I ACI I I im M -P -M of - f LTI P OF pjji. oF I it -1 1 Q. m riu-S.-s- !0 kli�ll I R[NLA I& AWVc� ---------- DI''MI-111P WIDTH. --., i t Nt. i F I Log Crib --16 Crib S 1.ze: P Df P1 I I - I'DOivl; WI:I- -10TA.L L1-FrCF1V'- kult [)M'; 1 IC'! M AM S1 10 r I N, AP.1101?p I IONI AM A. PVAI 1. A111 -A) ,eI I Depth: epth (A-1 Distanee, To: Lot, Lino .1 (19: Sewer Line: i pe Ma L e r i a I of Bedrooms: ns,Lal ler: STEP14GAC— .emark, N,- I I �- � K -`� �� �VA ������� \ �m DEPHR[MENT [ EIL- TH HND IRUNMENTHL ' /ECTlCIN n\,. 825 'L :nlREl-T, HNCHORHGE/ HK ON \\ ^\ 279�2511 ~~D 05 HE 14 K to! W lh� 1001 AL P PERMlT NU ( 7781] ) |PPLICHNT S[EPHENS CUNSkTUC|IUN ]810 � WOOD LOUP j49 2I16 ^ £GHL LO|4 HL J. SILV6R CREST SUB LOT S1ZE 4721@ SQUHH� FEET YPE UF lL 1 .1BSUR8lION SYSTEM (S: THENCH 11AXlMUM NUM8ER OF BEDROOM 4 SOIL RHTlNG (SQ FT/BR)� 95 ^HE REQUIRED SIZE OF THE SOIL H8SOHPTIUN SYSTEM IS� .1- U.����W-1 N on! Q If����� lHE LENGTH DlMENSION lS 'I HL. I [H (lN FEBl OF THE TRENCH UR DRHIN1 "lELD THE DEPTH OF H TkENCH OR PIT lS THn DISTHNCE BE|WEEN THE SURFHCE OF THE GROUND HNA THE 8UTTOM OF THE EXCHVHTlUN (IN FEET) THERE IS NO SE[ WIDlH FOR TkGNCHES THE GRHVEL 0EPTH lS THE MINIMUM DEPTH OF GRAVEL. BETWEEN THE OUTFHLL PTFIE HND THE BOTTOM OF TAk.: EXCHVHTIUN (IN FEET) is fit U :1 ll� 0 :,'4 1 `;;:', 4 - :11-' KL:- -0 - FA VA I X 21" If U --i������ ���__����_ ���������10�2 I����.� ��������IN ���~_~~�_�� � PHCKHGE PLHNT MHY BE 1NSTHLL6D AT |HE PERMlTTEE'S OPTION SU8JE.CT l 0 |HE OLLUWING CONDIllONS: K EITHER H CL8SS I OR ll NSF HPPRUVED PLANT MHY BE ITHLLED 2t H CONTINUUM MHINlENHNCE HGREEMENT IS RIL: QUlREC\ IF H MHlNTENHNCE HGREEMLi: NT IS NOT KEPT CURRENT ;OU MAY BE REQUIRED TO ENLHHGE THE SQlL H85URPTION SYSlEM HND/OR YOU MHY BE SU8JECT TO PROSECUTION �������������� 0'11-4 �11_� 11-7— kj.�. if~ :T.: ��VA�� �4 =_' .� �HCKFlLLING OF HNY SYSTEM WITH0UT FINAL. INSPECTlQN HND HPPROVHL BY lHlS )EPHRTI'll WILL 8E SU8JECl TO PROSECUTION 1INIMUM DlSTHNCE BETWEE@ H WELL HND HNY ON—SITE SEWHGE DISPOSHL SYSTEM IS L00 FEET FUR H PRIVHTE WE�L UR 200 F�ET FOR 11 PU8LIC WELL �ELL LOGS FIRE REQUIRED HN0 MUST 8E kETURNED TO THE DEPHRTMENT WlTHIN 30 DHYS ]F lHE WELL COMPLBION JTH�R REQUIREMENTS MHY lFlCHTIONS HNC, CQNSlRUCTILIN DIHGRHMS HkE �VHILH8LE TO INSURE PROPER INSlHLLHllON low K IN IN 1,~U~ ������kn' ���If �11 li�� 11:7�.: 11- 2! I CERTIFY THHl 1� I HM �HMILlHR WITH THE KEQUlREMEN[S FUR UN—S�TE SEWERS F��/ WELLS HS SET FURlH 8Y THE MUNICIPHLIlY OF HNCHORHGE 2l WILL INSTHLL lHYSTEM IN 0CCOADHNCE WITH THE COAES ]' l UNDERSTHND THHT lHE ON~SIlE SE�ER �YSlEM MHY REQUIRE ENLHRGEMENl lF |HE HESIDENCE IS REMUDELED TO INCLUDE MOkE THHN 4 BEDRUOM� yIGNED: Lot 4, Block 1 Silver Crest Sub. TABLE A Date: Logged By: 8/8/77 T.L. Barber W.O.9 10424 Test Hole No.Y Depth in Feet From To 0.0' 2.0' 2.0 2.5 2.5 10.0 10.0 11.0 11.0 15.0 15.0 20.0 Bottom of Test Hole: Frost Line: Free Water Level: SA. NO. Depth 2.5' 5.0 10.0 15.0 20.0 SOIL DESCRIPTION Brown Peat, Pt, wet, soft. F-2, brown Silty Sand, SM, wet. NFS-F2, brown slightly Silty Slightly Gravelly ~and, SP-SM, wet, medium density, subrounded and rounded particles to 3/4". F-2, brown Silty Sand, SM, with random gravel, wet, medium density. F-2, brown Silty Gravelly Sand, SM, with layers of Gravel and Sand, wet, medium d~nsity. F-4, brown Sandy Silt, SM, we~ to saturated, '" stiff. 20.0 ft. None observed 17.0218.0 ft. while drilling Type of Dry Unified M% Sample Strength Classification G SM G SP-SM G SM G SM G SM Remarks: 1) 2) 3) 4) 5) 6) Type of Sample, G=Grab, SP=Standard Penetration. Dry Strength: N=None, L=Low, M=Medium, H=High. Group refers to similar material this study only. General Information, see Sheet 1. Frost & Textural Classification, see Sheet 2 Unified Classification, see Sheet 5- 'M -W DRILLING, INC. 1 DRILLING LOG Well Owner Gi'n;:'i , :: (:ni.,:i en, ..' I-r.n. ;)pw. Use of Wel Location (address of: Township, Range, Section, if known; or distance main road T.nt. /,P. 'I Aowhrrr'noo Size of casing `> Depth of Hole I /' ' feet Cased to ' L% I • 1 feet Static water level :J ii ft. ?(akQve) (below) land surface. Finish of well (check one) open end Screen ( ); Perforated ( ). Describe screen or perforation RSA Well pumping test at :' gallons per (hBdr) (minute) for --!—hours with 100%, >ft, of drawdown from static level. Date of completion 1. 1/ J i./ 77 WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness r' TO C:rr.:lo.,, ni:i.r•latn TO TO TO TO TO TO TO --TO- 0.r. k-ju'.1 _TO O:ckJu.. o; Vot r,N: 11• Ir..tiir:t' (L;nv-:1.'Ly hccrilpttrr ' _ t.l,tt-c:•t• eravr•1. C:rrtifi;at hos. IILI !f. rri 2 —STATE TO TO i TO TO TO ,t ' 0 41 TO TO TO TO TO TO TO --TO- 0.r. k-ju'.1 _TO O:ckJu.. o; Vot r,N: 11• Ir..tiir:t' (L;nv-:1.'Ly hccrilpttrr ' _ t.l,tt-c:•t• eravr•1. C:rrtifi;at hos. IILI !f. rri 2 —STATE Describe screen or perforation Well pumping test at gallons per (h6ur) (minute) for —hours with t. of drawdown from static level. Date of completion WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness )M -W DRILLING, INC. TO TO TO TO DRILLING LOG Well Owner Use of Well Location (address of: Township, Range, Section, if known; or distance main road J Size of casing Depth of Hole feet Cased to feet Static water level """_ft. (p�}�qve) (below) land surface. Finish of well (check one) open end Screen Perforated Describe screen or perforation Well pumping test at gallons per (h6ur) (minute) for —hours with t. of drawdown from static level. Date of completion WELL LOG Depth in feet from ground surface Give details of formations penetrated, size of material, color and hardness , , , Tn i . I _ TO —TO- -TO— TO— TO— '-!Lp.1 ('v I I L I L I I G ; E 2 —STATE TO TO TO TO TO , , , Tn i . I _ TO —TO- -TO— TO— TO— '-!Lp.1 ('v I I L I L I I G ; E 2 —STATE FROM Municipality of Anchorage REQUEST FOR VOUCHER CHECK Health & Human Services (DEPARTMENT) TO: MUNICIPAL CONTROLLER DATE: July 31, 1996 m �75n? THIS SECTION FOR ACCOUNTS PAYABLE USE ONLY 1099 VOUCHER NO, PAYMENT DT. V VENDOR NO. REFERENCE NO. INVOICE DATE INVOICE NO. DESC Org. No.: -Phone No.: R� !�[A' CHECK NO. CHECK DATE PREP APPR 1. REQUEST THAT A MUNICIPALITY OF ANCHORAGE CHECK BE ISSUED TO: Name S & S Engineering Address 17034 Eagle River Loop Road, Suite 204, Eagle River, Alaska 99577 2. THIS PAYMENT IS FOR THE FOLLOWING (SUBSTANTIATION ATTACHED): The application for a Certificate of Inspection (Health Authority Approval) has been cancelled by the engineer (S & S Engineering). They have informed this office this application is not required now by the lending agency. The section has not performed any inspections or review so please -:refund the following: Lot 4A Block 1 Silver Crest (OS -02064/0988) n. sIUNA I Unts C m� -4744 Employee P ne No. 7. INSTRUCTIONS Approving Authority a. To be used only when payment cannot be made by purchase order, travel expense report, travel authorization or petty cash. b. Must be approved by department head unless approval authority is delegated in accordance with Policy and Procedure 24-7. c. Retain carbon copy for your file. 40-001 (Rev. 2191) MOA#15 AUTHORIZED USE ONLY z ... (6) 0 NOTIFY DEPARTMENT EMPLOYEE ... WHEN CHECK IS READY IN FINANCE Org. No.: -Phone No.: R� !�[A' _� I, �I • n �• 11111111DESCRIPTION■11111111 � 1II a AMOUNT5. TOTAL .. CHECK �� UI n. sIUNA I Unts C m� -4744 Employee P ne No. 7. INSTRUCTIONS Approving Authority a. To be used only when payment cannot be made by purchase order, travel expense report, travel authorization or petty cash. b. Must be approved by department head unless approval authority is delegated in accordance with Policy and Procedure 24-7. c. Retain carbon copy for your file. 40-001 (Rev. 2191) MOA#15 Municipality of Anchorage • '� DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Services Division Telephone; 343-4744 A ON-SITE SERVICES FEE DOCUMENTATION OS- 02064 Date Paid: 7 ZZ Permit Number: _ Name of sayer: (Name, on Check) Receipt #: 17 _ Mailing Address: (Off of the b3 44 Legal Description( y.� Z ,,� q?J 77 Check #: Type of Payment: (Indicate Amount Paid) Health Authority: 3� ' Excavator Permit: WAIVERS: Lot Line: Sewer & Well Permit: Engineer Permit: Well to Tank: Well Permit: Pumper Permit: Well to Field _ Sewer Permit: — Well Driller Permit: Field to Surface Water Copy Request: Tank Manufacturer: Tank to Surface Water (Waste Treatment) 72-034 (Rev. 10/87) DISTRIBUTION: WHITE—MASTER FILE CANARY—PROGRAM FILE • Municipality of Anchorage On -Site Water and Wastewater Program (907) 343-7904 CERTIFICATE OF ON-SITE SYSTEMS AP Parcel I.D. 015-062-59 Expiration Date: 1. GENERAL INFORMATION Complete legal description Silver Crest S/D BLOCK 1, LOT 4A Location (site address) 9340 Grover St, ANCHORAGE, AK 99516 Current Property owner(s) Tom & Susan Senter Day phone Mailing address Real Estate Agent 636 Barrow St, ANCHORAGE, AK 99506 2. TYPE OF DWELLING: ® Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) Day phone A 3. NUMBER OF BEDROOMS: 5 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well ® Individual Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ Waiver/Variance request for: Received by: i/I A-1 Date: COSA to be released to the engineer, unless otherwise requested by the engineer. COSA Fee $ 3(41-W Waiver Fee $ _ Date of Payment 511315Date of Payment Receipt Number iM-D Ipp Receipt Number, COSA# 6n0S1?13 Waiver# 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, based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) 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(are) in compliance with all applicable Municipal and State codes, ordinances, and regulations in effect at the time of installation. Name of Firm LUKE RANDALL, P.E. Phone 408-540-0390 Address 3301 EAST 41ST AVE Engineer's Printed Name LUKE RANDALL. PE 6. DSDSIGN TURE System #1 Approved for bedrooms. System #2 Approved for bedrooms. Disapproved. Date 05/12/15 ALj Lt, moo° a9 T" Conditional approval for bedrooms, with the following stipulations: f ° ° o_ h, an all o u< 1tiz115_° ° F,s. By Original Certificate Date: The M cipalit of nchor,�Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineers work. 7. ATTACHMENTS: COSA Checklist X Septic System Advisory Well Flow Advisory COSA blue sheet 10-10-12.doc Nitrate Advisory Arsenic Advisory - Other If more than 1 septic system is on the lot: COSA Checklist # _of _ Structure served by this system _ Certificate of On -Site Systems Approval Checklist Legal Description: Silver Crest S/D BLOCK 1. LOT 4A Parcel ID: 015-062-59 A. WELL DATA Well type Private if A, B, or C provide PWSID Date completed 1112111977 Sanitary seal (YIN) Y Total depth 143 ft. Cased to 141 ft. FROM WELL LOG Date of test . 1112111977 Static water level 80 ft. Well production 5 g.p.m. WATER SAMPLE RESULTS: Well Log (Y/N) Y Wires properly protected (YM) Y Casing height (above ground) 14 in. AT INSPECTION 412212015 ft. Coliform NEG colonies/100 mL Nitrate ND mg/L Arsenic: 7.65 ug/L Date of sample: 412212015 Collected by: Mike Anderson B. SEPTIC/HOLDING TANK DATA Tank Type/Material SEPTIC I STEEL Date installed 613012000 Tank size 2000 gal. Number of Compartments 2 Cieanouts (Y/N) Y Foundation cleanout (YIN) Y Depression over tank (Y/N) N High water alarm (Y/N) Y Date of pumping 412212015 Pumper AROUND THE CLOCK C. ABSORPTION FIELD DATA =1985 SYSTEM TESTED Date installed 613012000 Soil rating (g.p.d.tft2 orflz/bdrm)1.2 System type DEEP TRENCH Length 45 ft. Width 2 ft. Gravel below pipe 6.96 ft. Total depth 9.2_10 ft. Eff. absorption area 625 fe Monitoring tube Y Depression over field N Date of adequacy test 412212015 Results (Pass/Fail) PASS For 5 bedrooms Fluid depth in absorption field before test 32 in. Water added 800+ gal. New depth 46.5 in. Elapsed Time: 1200 min. Final fluid depth 36 in. Absorption rate >= 800+ g.p.d. Any rejuvenation treatment (past 12 mo.) (YIN & type) N If yes, give date D. LIFT STATION Date installed 613012000 Size in gallons 2000 Manhole/Access (Y/N) Y "Pump on" level at 3� 9 in. "Pump off' level at 39 in. High water alarm level at 44 in. Datum Bottom of Tank . Cycles tested 4 Meets alarm & circuit requirements? Y E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 1001+ Absorption field on lot 1001+ Public sewer main 751+ Sewer /septic service line 25'+. Animal containment areas 50'+ SEPTIC/HOLDING TANK ON LOT TO: On adjacent lots 1001+ On adjacent lots 1001+ Public sewer manhole/cleanout 100'+ Holding tank 100'+ Manure/animal excrete storage areas 1001+ Building foundation 51+ Property line 51+ Absorption field 51+ Water main 104 Water service line 101+ Surface water 1004 Wells on adjacent lots 100'+ ABSORPTION FIELD ON LOT TO: Property line 101+ Building foundation 101+ Water main 101+ Water Service line 10'+ Surface water 1001+ Driveway, parking/vehicle storage 104 Curtain drain 50'+(NoneKnown) Wells on adjacent lots 1001+ F. COMMENTS G. ENGINEER'S CERTIFICATION I certify that I have determined through field inspections and review of Municipal records that the above systems are in conformance with MOA COSA guidelines in effect on this date. Engineer's Printed Name LUXE RANDALL, PE Date 0511212015 COSA canary sheet 2.6-15.doc Lucas M. Randall CE —1 5 i I !' MUNICIPALITY OF ANCHORAGE • `- I 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.D. #1'l - HAA # 1. GENERAL INFORMATION Complete legal description Lot 4A,• Bloak 1 .Wve i. Cne.3t Subd .v.i4ion Location. (site address or directions) 9340 Ghave.K Dki.ve, Anchwtaoe, AK Property owner _Tara Sentefc Day phone 346-3278 Mailing address 636 P,aicnoty Anchanage., AK 99501 Lending agency Day phone "Mailing address = Agent Day phone Address Unless otherwise requested, HAA will be held for pickup, �t ,,, 2. NUMBER'1 F BEDROOMS: _ 3. TYPE OF WATER SUPPLY: Individual well XXX Community well Public water 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: Individual on-site XXX Holding tank Community on-site Public sewer NOTE: If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1191) Front MOA #21 - - 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. S & S ENGINEERING Name of Firm 17034 EagleLRiver Loop Road No 204 Phone city — 7--/ Eagle River, Alaska 99577 Address 0! A Engineer's signature 74 At_ Date P�re, OF q 011 Pte, ROBERT C. COWAN �I x CE .8801 rQ 6. DHHS SIGNATURE �aiV r4a,'^ Approved for bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: < Additional Comments F� ' 0�0 By: n �� Date �.� 4e 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. 72-025 (Rev. 1/91) Beck MOA #21 Municipality of Anchorage DEPARTMENT OF HEALTH & HUMAN SERVICES Environmental Services Division 825"L" Street, Room 502 • Anchorage, Alaska 99501 • (907) 343-4744 MUNICIPALITY OF At4CHOMGE ENVIRONMEWAL SERVICES DIVISION Health Authority Approval Checklist JUL 22'99S Legal Description: L 0 T J-14. ata C'c S /I vf" g PParcel I.D.: �® A. WELL DATA Well type F A , v # r f- _ If A, B, or C, attach ADEC letter. ADEC water system number Log present 6/M Y /2- S' Date completed I / l a I / 1 7 Total depth I q 3 Cased to Sanitary seal &N) -Y S FROM WELL LOG Date of test 11 / XI /7 7 Static water level 5" 0 Well production g,p,m, WATER SAMPLE RESULTS: Coliform 0 Date of sample: G / a I / 9 iv Nitrate B. SE r OLDING TANK DATA Date installed I ' / "b X77 Tank size I) S' o, Casing height (above ground) 1 /11- Wires properly protected AT INSPECTION v� s Other bacteria Collected by: 5 & S ENGINEERING 17034 Seq6 River 166ep Read No. 204 Eagle River, Alaska 99577 Number of Compartments _ 2- Cleanouts� Y S' Foundation cleanout 6//I) YD'S Depression (Y/i0 10 High water alarm (Y/O `" Date of Pumping :r l g 01 (a Pumper I. I C. ABSORPTION FIELD DATA Date installed 11 1101-77 _ Soil rating (g.p.d /ftz or2/bd `ys- _ System type .7 A iK c N Length 3 C1 Width q S Gravel thickness below pipe S`- S- Total depth / )L / Effective absorption area rl `I 4' Monitoring Tube presentO/N) Yf.S Depression over field (Y/6) N o Date of adequacy test I a /S °i S'- Results (Pass/Fail) P/3 -S -S For H bedrooms Fluid depth in absorption field before test (in.); I 6 " Immediately after6'13H3 gal. water added (in.): d '0 Fluid depth 1 '4 (ins.) Minutes later: >o 3L Absorption rate = L 0 0 + g p d Peroxide treatmentast 12 months P10/it k No u N (p ) (YA`i) iv0 � If yes, give date D. LIFT STATION Date installed Manhole/Access (Y/N) High water alarm level at* Cycles E. SEPARATION DISTANCES Size in gallons "Pump on" level at* SEPARATION DISTANCES FROM WELL ON LOT TO: i Se olding tank on lot I o c� Absorption field on lot 1 0 U f Public sewer main Sewer /septic service line On adjacent lots On adjacent lots off' level at* lclo�f Al Iq Public sewer manhole/cleanout N 14 J / f Lift station u14 SEPARATION DISTANCES FROM SEPTIC OLDING TANK ON LOT TO: Building foundation i; f Property line / f Absorption field Water main/service line f Surface water/drainage Wells on adjacent lots o '� SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO: Building foundation �L o f Property Line / 0 4" Water main/service line a S` Surface water Driveway, parking/vehicle storage area Curtain drain fV ° v JJ, u ^' o `" 'V Wells on adjacent lots /00 } F. ENGINEER'S CERTIFICATION I certify that I have determined thru field inspections and review of Municipal records that th st in conformance with MOA uideline in effect on this date. OF �J Signature A Engineer's Name /L 0 /3 /c2 r C• CQ r 4/••� laehc`n '7 � d t � 9 � ..... �...: _:. Date /�/.. -A ROBERT C. COWAN A O'.% CE • GSOI HAA Fee $ � D-, , CJD j Date of Payment Receipt Number Rev. 8/95 OSS: haa.wk.doc Waiver Fee $ Date of Payment Receipt Number are f CT&E Environmental Services Inc. ® — Laboratory Division Laboratory Analysis Report CT&E Ref.## 962509.962509001 Client Sample ID Lot 4A Block 1 Silver Crest Matrix Drinking Water PWSID 0 Parameter, Nitrate -N Total Coliform �S Collected Date 06/21/96 Technical Director: Stephen C. Ede Released By ' 42— z . Results QC PQL Units Method Qual _ 0.106 0.100 mg/L EPA 353.2 0 0 col/100ml- SM18 92228 Allowable Prep Limits Date Analysis Init Date _ 06/23/96 Elizabeth 06/21/96 WEP U - Undetected LT - Less than GT - Greater than D - Secondary Dilution J - Below the calibration range 0 cn .n 200 W. Potter Drive, Anchorage, AK 99518-1605 — Tel: (907) 562-2343 Fax: (907) 561-5301 3180 Pager Road, Fairbanks, AK 99709-5471 — Tel: (907) 474-8656 Fax: (907) 474-9685 ENVIRONMENTAL FACILITIES IN ALASKA, CALIFORNIA, FLORIDA, ILLINOIS, MARYLAND, MICHIGAN, MISSOURI, NEW JERSEY, OHIO, WEST VIRGINIA MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION DIVISION OF ENVIRONMENTAL HEALTH CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL�_,�p OF ON-SITE SEWER AND WATER FACILITY 264-4720 Application Date October 21, 1986_ 1. GENERAL INFORMATION (a) Legal Description (include lot, block, subdivision, section, township, range) Lot 4A; Block 1; Silver Crest Location (address or directions) 9340 Grover Drive (b) , Applicant Name Robert Rowen Telephone: Home 345-1319 Business 344-7775 Applicant Address _Omni Medical Center, 615 East 82nd, Suite 300, Anchorage, Alaska (c) Applicant is (check one): Lending Institution ® ; Owner/builder [.� ; Buyer I:1 ; Other ® (explain); _ (d) Lending Institution National Bank of Alaska Telephone - Address C Street Branch, Anchoraqe, Alaska (e) Real Estate Company and Agent 2001 Realty Cynthia Burriss Address — HHTeellephone 276-2001 (f) �(a�lithe HAA to the following address: S & S Engineering SRB 196X Eagle River Road --- EEagle River, Alaska 99577 ordered by realtor 2. TYPE OF RESIDENCE Single -Family E2� Multi-Fam' y El Other Number of Bedrooms 4 3. WATER SUPPLY Individual Well R7 Community 0 Public 0 Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 4. SEWAGE DISPOSAL. Onsite 10 Public EJ Community L7 Holding Tank El 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) 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 ins9e�cti� ��l��IVEERIIVG Name of Firm Telephone 511 B 196—-� 4 Address Date 6, �•Y l'YI��hHt 4e .y� ,'rtff (;vrJt\Wher 6. DHEP APPROVAL `—q / Approved for bedrooms by ©ate C - 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 engineer registered in the State of Alaska. The DHEP does this as a courtesy to purchasers of homes and their lending institutions in order to satisfy certain federal and state requirements. Employees of DHEP do not conduct inspections or analyze data before a certificate is issued. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. Page 2 of 2 72-025 (11/84) MUNICIPALITY OF ANCHORAGE (MOA) Mt1Nt DEPjt Y OHEAtT}�1V�.' A'AUTHORITY APPROVAL (HAA) EN`11RONMENTAL pROT264 E>�'�d�CKLISFEBRUARY �Ba UARY 1984 `J 1996 Legal Description: A. WELL DATA lti c l L. Well Classification S If A, B, C, D.E.C. Approved (Y/N) Ir�t Well Log Present (59N) Date Completed Yield Total Depth Cased to — Depth of Grouting Static Water Level � Pump Set AtyY u Casing Height Above Ground _ Sanitary Seal on Casing6DN) _ Electrical Wiring in Conduit (DN) Depression Around Wellhead (Y[ff� Separation Distances from Well To Septic/hiakfiT g Tank on Lot \ F?o I k ; On Adjoining Lots � c":::'�k To Nearest Edge of Absorption Field on Lot l ao Ik ; On Adjoining Lots L ao�k To Nearest Public Sewer Line )P To Nearest Public Sewer Cleanout/Manhole tN7A To Nearest Sewer Service Line on Lot ZS t -i Water Sample Collected by -S S 15 S(.tr-)EXv,z�'JU ; Date Water Sample Test Results ken `' Comments yu-_ . '1-0 PTzc'vJ4_1�tt� G PSS 45 l G B. SEPTICA4GL-B+f4G TANK DATA Date Installed kk-k -11 Size �-2-S0 No. of Compartments Z' Standpipes ON) —Air -tight Caps ON) Foundation Cleanout(DN) Depression over Tank (Yo _ Date Last Pumped Pumping/Maintenance Contract on File (Y/N) 1p, ; for Holding Tank High -Water Alarm (Y/N) Temporary Holding Tank Permit (Y/N) P Separation Distances from Septic/HeH itg-Tank: To Water -Supply Well N. © o t'"- — To Building Foundation _ To Property Line To Water Main/Service Line Course Comments Page 1 of 2 72-026(1 1/84) 1 + - To Disposal Field To Stream, Pond, Lake, or Major Drainage , C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata -AS 47)efL� Type of System Design Date Installed 11 \ 0-11 Length of Field -311 t Width of Field 4t 0 Depth of Field Gravel Bed Thickness 5 'S Square Feet of Absorption Area �a Standpipes Present (9N) Depression over Field (YIP Date of Last Adequacy Test l o-Ze- 3b Results of Last Adequacy Test C22 Separation Distance from Absorption Field: To Water -Supply Well ao t A_ To Property Line \ olk To Building Foundation Zto To Existing or Abandoned System on Lot r�l A ; On Adjoining Lots ^''C:> (a' To Water Main/Service Line \ j To Cutbank (if present) To Stream/Pond/Lake/or Major Drainage Course oa To Driveway, Parking Area, or Vehicle Storage Area S ! Comments D. LIFT STATION QIP Date Installed Dimensions Size in Gallons Manhole/Access (Y/N) "Pump On" Level 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 ** I certify th�t I tichDGked�fN deo, or conformed to all MOA and HAA guidelines in effect on the date of this inspection. Signed �fc IVISR B )C Date Z //9 Company , MOA No.fl fr _ aw Receipt No. C/� OCA ( -. GU j +va.�*( dF At Date Date of Payment MUNICIPALITY OF ANCHORAGE 10t_�j�v s Amount: $ C/ a DEPT. OF HEALTH & p�. eef� �� * _ •3 ENVIRONMENTAL PROTECTION •,be 43sbYrt A. OCT 2 ANN t4o. tdd , Page 2 of 2'�� RECEIVED 72-028 (11/84) 5. LEGAL DESCRIPTION DATE RECEIVED INSPECTION APPOINTMENTS S/D TIME TIME TIME I % 3 C) C�C.�`'� `^ / ek DATE - DATE - - nnr DATE O Two 0 Five 0 MULTIPLE FAMILY 0 Three 0 Six INSPECTOR INSPECTOR( INSPECTOR lI * ATTACH WELL LOG. A well lag is required for all wells drilled O COMMUNITY since June 1975. For wells drilled prior to that date, give well MUNICIP Y c 8. SEWAGE DISPOSAL SYSTEM DEPT. Gr T"; MUNICIPALITY OF ANCHORAGE [N'✓1R01,,:CTION DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION 825 L Street - Anchorage, Alaska 99501 NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING, CAN BE INITIATED. ENVIRONMENTAL SANITATION DIVISION Telephone 264-4720 RECEIVED REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SEWER FACILITIES DIRECTIONS: Complete all parts on page 1. Incomplete requests will not be processed. Please allow ten (10) days for processing. 1. PROPERTYOWNER PHONE Robert and Lorna Kramer 344-5768 MAILING ADDRESS - SRA Box 77 L PROPERTY RESIDENT (If different from above) PHONE Same 2. BUYER PHONE Tom & Lee Crawford 243-4117 MAILING ADDRESS 6652 LakewaY Drive 3. LENDING INSTITUTION - PHONE Alaska State Bank 279-7637 MAILING ADDRESS - 4. REALTOR/AGENT - PHONE Dynamic Realty- Connie Yoshimura Petie St -ran R" 279-7611 MAILING ADDRESS 501 l9. Northern LiHhts Blvd. Anchorage 99503 5. LEGAL DESCRIPTION Lot 4A, Block 1, Silvercrest S/D STREET LOCATION 6900 Grover Drive 6.. TYPE OF RESIDENCE - NUMBER OF,BEDROOMS 0 One L&I Four 0 Other E� SINGLE FAMILY O Two 0 Five 0 MULTIPLE FAMILY 0 Three 0 Six 7. WATER SUPPLY EX) INDIVIDUAL* * ATTACH WELL LOG. A well lag is required for all wells drilled O COMMUNITY since June 1975. For wells drilled prior to that date, give well O PUBLIC UTILITY depth (attach log if available.) 8. SEWAGE DISPOSAL SYSTEM ® INDIVIDUAL/ON-SITE** 1978 YEAR ON-SITE SYSTEM WAS INSTALLED. 0 PUBLIC UTILITY NOTE: THE INSPECTION FEE MUST ACCOMPANY EACH REQUEST BEFORE PROCESSING, CAN BE INITIATED. 72-010 (Rev. 6/79) 1_,_ Gr\ THIS SIDE FOR OFFICIAL USE ONLY 1. TYPE OF RESIDENCE ❑ SINGLE FAMILY ❑ MULTIPLE FAMILY NUMBER OF BEDROOMS ❑ ONE ❑ THREE ❑ FIVE ❑ OTHER ❑ TWO ❑ FOUR ❑ SIX 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 [--]PUBLIC UTILITY Connection Verified PERMIT NUMBER DATE INSTALLED l _ INSTALLER Z . ❑Septic Tank or ❑ Holding Tank Size: ( -) w If Tank is homemade give dimensions: SOILS RATING TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL _ --v` 4. DISTANCES WELL T0: Septic/Holding Tank Absorption Area Sewer Line Nearest Lot Line Absorption Area to nearest Lot Line 5. COMMENTS ffi APPROVED FOR BEDROOMS ❑ CONDITIONAL APPROVAL (letter must accompany certificate) ❑ DISAPPROVED DATE BY jY \n� 72-010 (Rev. 6/79) "IJNICIPALITY OF ANCHORAGF DEPARTMI .' HEALTH AND ENVIRONMEN L ROTECTION 825 L Street, Anchoraup., Alasxa 99501 .264-4720 #l: Time 1:30 p.m. #2: Time Date 3-22-78 Wed Date Date Received: March 21, 1978 #3: Time Date Insp Pratt Insp Insp -- REQUEST FOR APPROVAL OF INDIVIDUAL SEWER AND WATER FACILITIES 1. Lending Institution Request: Mailing Address: Phone: 2. Property Owner Stephens Construction Phone: 349-4675 —� Mailing Address: _ Post Office Box 3-3772 ECB _-- 3. Legal Description: Lot 4 Block 1 Silver Crest Subdivision — 4: Single Family Residence: (x) Number of Bedrooms: Four Multiple Family Residence: ( ) Number of Bedrooms: 5. Well System: Individual Well (x) Community/Public System ( ) Permit # Depth of Well Well Log on File (x) Construction Bacterial Analysis 6 Sewage Disposal System: On-site System (x) Public Utility ( ) Permit # Installed 1977 Installer Septic Tank Size )a5:6 Manufacturer Absorption Area Soils Rate c/s- Material 7. Distances: Well to Septic Tank to Sewer Line to Nearest Lot Line Nearest Lot line to Absorption Area Absorption Area Page Two Department of Health and Environmental Protection Request for Approval of Individual Sewer and Water Facilities Legal Description: Lot 4 Block`1 Silver Crest Sudivison Comments: — Affadavit Attached: Letter Attached: ( ) Approved: Date: Disapproved: Date: Department Worksheet: mUNICIPALITY OF ANCHORAGt_ Department of health and Environmental. Protection o ,.-. 825 L Street-, Anchorage, Alaska 99501 M1� i 264-4720 Request for Approval of Individual Sewer_ and Water Facilities 1 . Property Owner: Mailing Address: y -r\1 �' Phone: 2 Name of Buyer: Mailing Address: Phone: 3. Lending Institution: _ Mailing Address: —_ Phone: 4. Realtor/Agent: Mailing Address: Phone: _— 5. Legal Description: Street Location: 6. Single Family Residence: (vr Number of Bedrooms: Multiple Family Residence: ( ) Number_ of Bedrooms: 7. Water Supply:_ *Individual Well (v) Public/Community System ( ) If Individual Well, well depth If Community System, name of system 8. Sewage Disposal System: *'On-site System ( ) Public System ( ) If On-site System, date of installation: *NOTE: A well log is required on ALL wells drilled since 6/75. **If on-site sewer system is over two(2) years old, an adequacy test is required by this department. A fee of $25.00 must accompany each .request before processing can be initiated. 3/77