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HomeMy WebLinkAboutT11N R3W SEC 14 NE4NW4SW4NE4Municipality of Anchorage Community Development Department Page 1 of 2 On -Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage, AK 99519-6650 • http://www.muni.org/onsite • (907) 343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP141356 PID Number: 020-284-21 ❑ New ✓❑ Upgrade Name: DARELL KROLICK ABSORPTION FIELD ❑ Deep Trench ❑✓ Shallow Trench El Bed El Mound Address 6720 POTTER HEIGHTS DRIVE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 0.8 GPD/SF 7.0 Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade 3.0 Ft. Gravel depth beneath pipe 4.0 Ft. Subdivision Block Lot IUE W SW y N C__ Fill added above original grade 0.0 Ft. Gravel length 75 Ft. Township Range Section 11N 3W 14 Gravel width 5.0 Ft. Beds: Number of Lines N/A Distance between lines N/A Ft. SEPARATION DISTANCES To Septic Absorption Holding Sewer Total absorption area Number of trenches Dist. between trenches From Tank Field Lift Station Tank Line 375 z Ft 1 N/A Ft. Well 101.0 100.8 N/A N/A 54.8 TANK El Septic ❑ S.T.E.P. ❑ Holding ❑ Other Manufacturer ANCHORAGE TANK Capacity 1250Gal. Surface Water 100+ 100+ N/A N/A Material Number of compartments Lot Line 62.5 27.0 N/A I N/A STEEL 2 NA Foundation 108.8 112.0 N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ 50+ N/A N/A Gal. Remarks Pump on level at in. Pump off level at in. High water alarm at in. Pump make and model Electrical Inspections performed by Installer PIPE MATERIAL House to tank 3034 Tank to 3034 drainfield ISAACS Drainfield 3034 CO/MT 3034 Inspector Pannone Engineering Services BENCH MARK (Assumed elevation) 1970.0ft Inspection s, dates: 6/12/15 2"d 6/12/15 Location and description 3rd 6/13/15 4'h 6/29/18 BOTTOM TRIM AT HOUSE POINT B COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp �' of AC Conditional Approval: Date .t�G • �s a� co �$¢ TH0. • • �iteven • . •�annorie• ' ��G� /�J%9 ®� • Approved Date �/ , * -.� inspection meport_ i- i- iz.aoc DESIGN PARAMETERS PRIMARY SEPTIC SYSTEM NO. BEDROOM: 4(600 gpd) TANK SIZE: 12508 PERC RATE: 5.3 MPI s. SOIL RATING: 0.8 GPD/SF X (pf.— t AREA ROD: 750 SIT REDUCTION FACTOR- 0.50 0 ADJUST ABSORPTION XREA: 262.5 m SYS. TYPE: WIDE TRENCH 4. O'E D j UE NORTH SCALE 1 = fly i MIN LENGTH: 75 LF rn cf) USED: DECOMMISSIONED EXISTING �DRIVEWAY 1940 -/' SEPTIC SYSTEM PER 75LFx5.0'Wx4.0' E.D., 7.0' TI) ;�MOA CODE 1945 1950 1955 1960 INSTALLED FOUNDATION TI CLEAN OUT 2 1965 DC 0 / % % / �( `/% / '- cl INSTALLED DRAIN FIELD 970 75LF x 5.0'W x 4.0'ED T A INSTALLED CLEAN 6UT AND X011975 MONITOR AT EACH END loo/. 1980 TH-1 4 BDR SPURKLAND 2014 SFD zi Xz WELL PERC PES M - C2 2 WELL RADIUS TO BE STAKED BY REGISTERED LAND SURVE:'Y0R-- z 0 1— D 0Z Z < Dw U 0- Ll 0 0 Zz Q<z W W m FILTER FABRICti DRAIN ROCK FV* APQVF PIPE INV Of z 4 < z L -"b RAIN PIP, 4.0 n-- ZJL � n n 1250g SEPTIC TANK 4.0' DRAIN ROCK GM 01 PROFILE SCALE:NTS I I A B —I Tl --j 11.3.6 1.9 T2 11 6.8 1 1115 DCO 117.8 1118 Cl 121,0 114.7 MI 122.5 11 15.9 C2 1-1-63.7 142.2 M2 1 161.7 140.2 GM 01 PROFILE SCALE:NTS I I l I 8/19/14 DATE PERFORMED: 7/22/14 NOTES: PAMONE ENG SVC, LLC P.O. BOX 102954 ANCHORAGE, AK 99510 Dote 1/8/19 RECORD DRAWING -S—ccle PHONE (907) 272-8218 FAX (907) 272-8211 *:':S TH .... .. CE 8149 1 " = 50' T11N, R3W, SEC 14 NJE4 NW4 SW4 NE4--U20-282-21 DAREDKROLICK 6720 POTTER HEIGHTS DRIVE P.I.D. NO PERMIT NO. OSPI41356 DRAWN ACP SITE PLAN ANCHORAGE, AK sheet 2 OF TH-PES xDDn0w*L pEnc ' 2 3 DATE PERFORMED: 6/5/2015 SO|LS LOCS — PERCOLATION TEST WAS GROUND WATER ENCOUNTERED? NIF YES, AT WHATDEPTH TO WATER AFTER. READING DATE CLOCK TIME NET TIME WA TER LEVEL READING NET DROP' RATE I (mPI) E4 1206 30 MIN 1T.600" 570'* 5.26 6 1237 30 MINI 11,550" 5.65 COMMENTS: Test hole d by ISAACS. J' SPURKLAND 2014 /11ELL R LSTO 3� �STAKEO B�Y REGISTERED ILAND SURVEYOR now TH I SOIL TEST RESULTS /ANALYSIS • PERCOLATION RATE 5.3 (minlinch) (Hydrologic Soils Group: HSG A) • PERC, HOLE DIAMETER 6" ° 'TEST RUN BETWEEN 5 FT AND 6 FT " TEST RUN FOR OVER AN HOUR, LAST THREE READINGS PROVIDED. NOTES: PANNONE ENCT SVC, LLC Date RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 1/8/2019 PHONE (907) 272-8218 FAX (907) 272-8211 Scale NTS 15R A WIN Ik!. CE 8149 6720 POTTER HEIGHTS DRIVE OSP141356 SOILS LOGS AN'—'HORAGE, AK Sheet 1 OF 1 QGREA" ANCHORAGE AREA BORr' GH Department of Environmental Quality 3330 C Street Anchorage, Alaska 99503 INSPECTION REPORT ON-SITE SEWAGE DISPOSAL SYSTEM LOCATION ~ ~ SEPTIC TANK: (,//, ~- ~ ]~/~h(,~ DISTANCE ~?_.~ ~-,~..~ >4 FROM WELL MANUFACTURER ~(-~- MATERIAL INSIDE LENGTH INSIDE WIDTH LIQUID DEPTH NUMBER OF COMPARTMENTS LIQUID CAPACITY //(~)(00 GALLONS. SEEPAGE PIT: ~'~'~(~/~3 ~'"'.2~ /(o~' ~, "- NUMBER OF PITS ~_~. DIAMETER_~OR WIDTH , LENGTH _, DEPTH 1'3 ~ L, N lNG MATE R ,AL.~(~~0 ?~ ' X DIAMETER ~EPTH DISTANCE FROM: WELL BUILDING FOUNDATION NEAREST LOT LINE TOTAL EFFECTIVE ABSORPTION AREA (WALL AREA) ADDITIONAL ABSORPTION WELl-: , ... ,~ -- TYPE ~1'I~L ~---~J~''¢ CONSTRUCTION BUILDING ~/OI' LOT LINE -~ NEAREST ~ FOUNDATION CESSPOOL OTHER SOURCES APPROVED DISAPPROVED NEAREST .~,,,~ t SEPTiC/0~, SEWER LINE TANK , REMARKS DISTANCE FROM: SEEPAGE / (~) (./~ SYSTEM DISTANCES: INSTALLED BY: ,~l~,z LOT SLOPE: DIAGRAM OF SYSTEM DATE ED G.A.A.R. Form NO, EQ-OG1 GREATER ANCHORAGE AREA BOROUGH DEPARTMENT OF ENVIRONMENTAL QUALITY 3330 'IC'I STREET ANCHORAGE, ALASKA 99503 SEWAGE DISPOSAL SYSTEM -- APPLICATION AND PERMIT INSTALLATION OF: SEPTIC TANK TYPE AND SIZE OF FACILITY TO BE SERVED '~' .o,,_ TE .T .ESU LTS COMPLETION DATE ANTICIPATED FINAL INSPECTION: 24 HOUR NOTICE REQUIRED. BACKFILLING OF ANY SYSTEM WITHOUT FINAL INSPECTION BY THE DEPARTMENT OF ENVIRONMENTAL QUALITY AUTHORITY WILL SE SUBJECT TO PROSECUTION. MINIMUM DI~;TANCE~,, REQUIREMENTS SEPTIC TANK TO SEEPAGE PIT WALL / ~% ( DRAIN FIELD SEEPAGE AREA - DIAGRAM OF SY.~TEM TO NEAREST LOT LINE. __%'__ WELL TO SEPTIC TANK ALSO CONS]DER AREA WELLS, ., SEEPAGE PIT [CJI CAST IRON INTO AND OUT OF SEPTIC TANK AND INTO Crib CROSS}NC GAP Of ExCaVATION 5 FEET]NTO UNDiSTURbED SOIL. 4 INCH DIAMETER CAST IRON SIPHON PIPES ON SEPTIC TANK AND SEEPAGE PIT FItTED WITH AIRTIGHT REMOVABLE CAPS. GRAVEL BACKFILL CONFORM TO BOROUGH REGULATIONS REGARD NSTALLATION. CERTIFY THAT I AM FAMILIAR WITH THE REQUIREMENTS OF GREATER CHORAOe AREA BOROUGH ORDINANCE NO. 28~68 AND THAT THE ABOVE DESCRIBED ~STEM IS IN ACC ANC ] H SAle) CODE'~~ ~S I N~;/PL~ll ;~/ -- /~ ~/~ ~'~E ~ --~(~ ~ Performed For .--~~.O_~,".l Date Performed LeGal ~escrin~on: Lot Blo'ck Subdivision ~a~WW~J~.m/Ic/~W/~ This Form Renorts Soils Lofl~w~ Perc~l-~tion 'r6st_~ye~/~ ~//~ neath Feet Soil Characteristics Was Ground Water Encountered? It Yes, At what Denth? Readinq Date Gross Time Net Time Denth to H20 Net Dron Percolation Rate Hinute Proposed Installation: Seepaoe Pit [/~a_. Drain Field Deoth of Iglet -.~/ DeDth T:8 Bottom Of Pit ~_5 Trench Test Performed B~ ~;~/~>-~', 72~F ~ Data Certified Cy:~/,~.s~ nat:~: 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 Parcel I.D. # CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING 020-281-21 HAA# 1. GENERAL INFORMATION Complete legal description T11N; R3W; Sec 14; NE4 NW4 SW4NE4 Location (site address or directions) Property owner ,Tc~hn C'c)~ · Mailing address' '(~/~ C~r~a~_] and Mortgage Lending agency Mailin. g address ' Agent Address 6720 Potter Heights Drive Anchorage, AY · Day ph0ne 345-3185 320! "c" st Anchorage, Day phone AK 99503 Day phone Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: NOTE: Individual well COmmunity well Public water XX If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. 4. TYPE OF WASTEWATER DISPOSAL: NOTE: Individual on-site x× Holdingtank Community on-site Public sewer If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-O25(Re¥.1/9~) Front MOAR21 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 regulatic ~ection. ~ffe..~ o.n th~ d~_te of tb. is'~insp Name of Firm Address . - EngineeCs signature Phone Date Alaska Water & Wastewater Consultants, Inc. Shall be PAID ,$ //,~. S -~--- al, '~ : · ~ pdor to, clos~g ~or the Engineerin~-Se~ices Provided. 6. DHH8 SIGNATURE A?prowd b droom=. Disapproved. bedrooms, with the following stipulations: __ Conditional approval for Additional Comments 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. RECEIVED Municipality of Anchorage 0CTll DEPARTMENT OF HEALTH & HUMAN SERVIC'~g~cIP^u~rY OFANCH( Environmental Services Division ENVIRONMENTAL SERVICES 825 L Street, Room 502 · Anchorage, Alaska 99501 · (907) 343-4744 Legal Description: A. WELL DATA Well type PRIVATE Log present (Y/N) Total depth .120' Sanitary seal (Y/N) Health Authority Approval Checklist NE 1/, NW 1/4, SW 1/4, NE 1/4-, T11N, R3W~ SECTION 14, Parcel I.D.: 020-281-21 *PER M.O.A. RECORDS 1 IfA, B, orC, attach ADECle~er. ADEC watersystem number YES Date completed Cased to .60' N/A YES *FALL 1974 Casing height (above ground). 2'+ FROM WELL LOG Wires properly protected (Y/N) YES Date of test Static water level *70' Well production *20 WATER SAMPLE RESULTS: Coliform ~ Nitrate Date of sample: / ~ '-/-'/- ~ ~ B, SEPTIC/HOLDING TANK DATA Date installed *.2EALJ.~_9.7_~ Tank size Foundation cleanout (Y/N) ,~;N,8- \i Date of Pumping 11/27/99 C, ABSoRpTION FIELD DATA Date installed *FALL 1974 Length *25' Width Effective absorption area *864- SO.FT. Date of adequacy test 9/29/99 AT INSPECTION *BEFORE 3/85 9/29/99 g.p.m. 5.9 g.p.m. o~ ' z//~ /~/~ Other bacteria Collected by: A.W.W,C., INC. *lnnn Number of Compartments U.K. Cleanouts (y/N)ONE Depression (Y/N) _J~O High water alarm (Y/N) N/A PumperA+ HOME SERVICES Soil rating (g.p.d./fF or fF/bdrm) *250 · 1 O' Gravel thickness below pipe System type CRIB '9' Total depth 1 6' Monitoring Tube present (Y/N)~ES__ Depression over field (Y/N) NO Results (Pass/Fail) pAgs For 3 bedrooms Fluid depth in absorption field before test (in.); 0" Immediately after1544 gal. water added (in,): 87.75" Fluid depth 34" (ins) Minutes later: 14-4-0 Absorption rate = 450+ q.p.d. Peroxide treatment (past 12 months) (Y/N) NONE KNOWN if yes, give date - 72-026 (Rev. 3/96)* LIFT STATION Date installed Size in gal Manhole/Access (Y/N) "Pu~ "Pump off" level at* High water alarm level at* ~ *Datum E. SEPARATION DISTANCES SEPARATION DISTANCES FROM WELL ON LOT TO: Septic/holding tank on lot 100'+ On adjacent lots 100'+ Absorption field on lot 117' TO RTANDPIPE On adjacent lots 100'+ Public sewer main N/A Public sewer manhole/cleanout Sewer/septic service line Lift station SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK ON LOT TO: Foundation 5% Property line ,5'+ Abso'rption field 5'+ Water main/service line I(Y+ Sudace water/drainage 100'+ Wells on adjacent lots 100'+ SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOTTO: Property line 1 r)'+ Building foundation 10' Water main/service line 10'+ Surface water 100'~ Driveway, parking/vehicle storage area 10'+ R Curtain drain ENGINEER'S CERTIFICATION ,nconforrnanc~with~J Hl~/~id, Signature ~,,~.,~ ;(~"~ Date NONE Wells on adjacent lots I inspections and / es in effect on this date. ,IF'F'F'RFY A ~ARNF~ Date of Payment Receipt Number 72-026 (Rev. 3/96)* Waiver Fee $ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & HUMAN SERVICES Division of Environmental Services On-Site Services Section P.O. Box196650 Anchorage, Alaska 99519-6650 343-4744 CERTIFICATE OF HEALTH AUTHORITY APPROVAL FOR A SINGLE FAMILY DWELLING Parcel I.D. # _L-'~%.Q.I'~ - .~\ - ~ \ HAA # 1. GENERAL INFORMATION Complete legal description NE~, NW~, SW~, NE~, Sec. 14, TIIN, R3W, S.M. Location (site address or directions) Property owner Mailing address Bruce Boyd 8C-31 Box 5083P 6720 Potty[ Heights Driv~ Anchoraq6, AK Day phone Wasilla, AK 99654 244-7277 376-3276 (h) Lending agency Mailing address_ Day phone. Agent Address Day phone e Unless otherwise requested, HAA will be held for pickup. NUMBER OF BEDROOMS: 3 TYPE OF WATER SUPPLY: Individual well ×XX Community well Public water NOTE: If community well system, provide written confirmation from State ADEC attest- ing to the legality and status of system. TYPE OF WASTEWATER DISPOSAL: Individual on-site Holding tank Community on-site Public sewer NOTE: XXX If community wastewater system, provide written confirmation from State ADEC attesting to the legality and status of system. 72-025 (Rev. 1/§t) 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 invest!gation 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 el Name of Firm S & S ENGINEI~R ] 7034 E, agle,~l,~ Address E~g,~, Engineer's signature ~:~ddatAi.oI t~is inspection. Phone Date DHHS SIGNATURE ~ Approved for ~-,~'~'~r~--~bedrooms. Disapproved. Conditional approval for bedrooms, with the following stipulations: Additional Comments 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. Municipality of Anchorage /~ Department of Health and Human Services HEALTH AUTHORITY APPROVAL CHECKLIST Lega Descr pt on ~J~ F~'/~ W ~/?[ 5~&/¢? / ~U~ ~/¥ Parcel I.D. A. WellData %E~.I~ ~-[I io/ R~/ ~',,M, Well type ~U~'~ ~ If A, B, or C, attach ADEC letter. ADEC water system number Log present ~N) Total depth Sanitary seal ~N) Date completed ~"~'¢~ ~ ~( Driller Casedto ~ ~0 ' Casing height Wires properly protected (Y/N) FROM WELL LOG Date of test Static water level Well flow Pump level1 O(~ ~. SEPARATION DISTANCES FROM WELL TO: Septic/holding tank on lot /~)¢ ~' Absorption field on lot /¢ 0 ~ Public sewer main Sewer service line WATER SAMPLE RESULTS: AT INSPECTION ; On adjacent lots ; On adjacent lots ~,Public sewer manhole/cleanout /~//,.A /0 ~..~¢_~z ~ /a~,/Petroleum tank /UOfvg ~'~o~ Coliform ("~ Date of sample: Il/l~l I'~ Nitrate Collected by: B. SEPTIC/I~!~I~ TANK DATA Date installed ¢' ~cc_ I~I~H Tank size ¢¢ t(~O© Cleanouts (t~N) (~'~_-~ Foundation cleanout (Y/~) High water alarm (Y/N) /~/,,/]r, Date of pumping ////2.- / ~' % %75'7¢/¢~ //U ?-o o~r~' /~?. Other bacteria Compartments__(/l~E. Depression ( Y/~/~ J~O Alarm tested (Y/r~ M/~ Pumper~ ~O~A~ ~UIC~ SEPARATION DISTANCES FROM SEPTIC/~ TANK TO: Well(s) on lot [(Jd~ '~' To property line c~O 'A Surface water/drainage On adjacent lots Absorption field Foundation Water main/service line 72-026 (3/93)° Front CONTINUED ON BACK PAGE Manufacturer / "Pu m.g.eff~evel at D. ABSOR~A Length 4¢ ¢~k_.~ Total absorption area Date of adequacy test Size in gallons Manhole/Access (Y/N) / Vent (Y/N) "Pu~t High water alarm level ~ Cycles tested'"' Meets MOA electrical codes (Y/N) ~ SEPARATION DISTANCE FROM~~ ~ Well on lot / On adjacent lots Sudace water I cl.'~:~ c'l Soil rating (GPD/FF) Width ;~f¢"! 0 ' Gravel thickness ~ ~ L~ E~ Cleanout present (~N) Water level in absorption field before test Peroxide treatment (past 12 months) (Y(~'~ SEPARATION DISTANCE FROM ABSORPTION FIELD TO: Well on lot /~6 r~L On adjacent lots To building foundation On adjacent lots ¢k)/~ Sudace water Total depth /'~ ,, ,'~/ Depression over field (Y/~"~ Results (pass/fail) ~s'~ for After test ~c~-? ,~1(~ ¢~ If yes1 give date System type Curtain drain /0© ~'/- Property line /00 ~¢- To existing or abandoned system on lot Cutbank /~/A Water main/service line D~vewCay, parking/vehicle storage area /00 Bedrooms E. ENGINEER'S CERTIFICATION I certify that I have checked, verified, or conformed~tto~all MOA and HAA guidelines in effect on the date of this inspection. Signature 37034 E=~C~,~ . fle Jlvar, AlasJ< 7 HAA Fee $ ~.~¢D , ~ Date of Payment Receipt Number Waiver Fee/~$ Date of Payment Receipt Number MUNICIPALITY OF ANCHORAGE DIVISION OF ENVIRONMENTAL HEALTH DEPARTMENT OF []LkLTH AND ENVIRONMENTAL PROTECTION APPLICATION FOR HEALTH AUTtt0R%TY APPROVAL CERTIFICATE 1o _G__e?_e~ral Information Application Date (a) Legal Descr:Lption~ (include lot, block, subdivision, section, to.ship, ~an~e) Locatiom (address or directions) (~) Applican~ is (chock one) Landing Institution ~j ; der ', (d) Landing Instigution ~~/~:' "7",'~_~q~¢~Z~['i~P/ Telep~ ........ (e) Address Real Lstate Co. & Agent Address~_ Telephone (f) Mail the HAA to the following address: ~Residence Single-Family~ Multi-Family~_~ Number of Bedrooms ~2% Other (describe) Water Su~l~_ Individual Well~ Community ~ Public ~ / Note: If community well system, must have ~.~itten confirmation from the State Department of Environmental Conservation attesting to the legality and status~ Note: If community well system, must have ~zrittee confi~nation from the State ~&~ Department of Environmental Conservatiou attesting to the legality and status° [Page 1 of 2] 5.~czngEn.ineerin ..........Firm Providing~~Ins ectione, .............. Teste~ Pile Search~ Data and Information As cergified, by my seal affixed hereto and as of the validation date shown below, ve~'ify that my investigation of this Health Authority Approval shows that the water supply and/or wastewater disposal, system is safe~ functional and adequate for the number of bedrooms and type of structure indicated herein.- I fur$her verify that~ based ou the information obtained from the Mmnicipality of Anchorage files and from :~y investigation and inspection, the on-site water supply and/or wastewater disposal system is in compliance ~.zlth all Municipal and State codes, ordinances, and regula~ tions in effect on ~he date of this inspection. (ENGINEER SEAL) DHEP A~_~r~gv~al' Approved Approved ~ Disapproved Terms of Conditional Approval Reid, Jr. Conditional CA~CION THE MUNICIPALI~ OF ANCHORAGE DEPARTMENT OF HEA~TH AND E~flRON%fENTAL PROTECTION (DHEP) ISSUES HE~TH AUTHORITY APPROVAL CERTIFICATES BASED SOLELY UPON T~ REPRESEN'?~ ATIONS GIVEN IN PARAGRAPH 5 ABOVE BY AN INDEPEndENT PROFESSIONAL ENGINEER REGISTERED IN THE STATE OP ALASKA. %~HE DHEP DOES THIS AS A COWRTESY TO PDRCihkSERS OF HOMES TNEIR LE~DING INSTITUTIONS IN ORDER TO SATISFY CERTAIN FEDERAL AND STATE REQUIRE- ME~fS. EMPLO~qES OF DHEP DO NOT CONDUCT INSPECTIONS OR ANALYZE DATA BEFORE A CERTIFICAIE IS ISSUED° ~iE MUNICIPALI~fY OF ANCHORAGE IS NOT RESPONSIBLE FOR ERRORS OR OMISSIONS IN THE PROFESSIONAL ENGINEER'S WORK. (DHEP SEAL) RR4/eJ/D18 [Page 2 of 2] 7-19~84 A. WELL DATA MUNICIPALITY OF ANCHORAGE (MOA) I~EALTH AUTHORITY APPROVAL (HAAi CHECKLIST - FEBRUARY 1984 Well Classification ~ Well Log P~esent ~N) Total Dept2% /~ ' Cased to Static Wate~ ~1 ~D / ~ Casing ~ight ~ G~nd Elec~ical Wi~ing in ~nduit~) ~p~ation Distan~s ~ ~11: To ~ptic~oldin~ Ta~ ~ ~t ~ To ~a~st ~ge of ~s~tion Field on ~t hi,'?, 0'1 19!35 Legal Description: _/d6~/Yz~' ,{,/~ fly ~te ~leted ///~ ~ Yield Pump Set At Sanitazy Seal on Casing ~N) De~ession A~ound Wellhead (Y~ ~ ; On Adjoining Lots //~_/~z--i' On Adjoining Lots To Nearest Public Sewer Line .4//~ To Nearest Public Sewer Cleancut/Manhole ~///~'. To Nearest Sewer Se~.vice nine on Lot Water Sample .Collected By /~, '~9 ; Date Water Sample Test P~sults $/~Tl:~l'z,~-~'7-~V' Air-tight Caps ~, ) B. SEPTIC/HOLDING TANK DATA Date Installed ~/k,~ Standpipes _~N) ' No. of Ccmpaztm~nts ~~ Foundation Clean,ut (Y~ / Dap~ession over Tank (Y~ Date Last Pumped Pumping/Maintenance Contract on File (Y/N)~/~ ; fc~ ' Holding Tank High-Water Alarm (Y/N) ~/~ Temporary Holding Tank Permit (Y/N) Separation Distances f~cx~ Septic/Holding Tank: To Water-Supply W~ll. /~-/ ~ To Building Foundation /~9/~ To P~operty Line ~50' .~ ...... To Disposal Field To Water Main/Service Lir~ ~-~O~-I ~ To Stream, Pond, Lake, c~ Major D~ainag~ co=se Receipt 9 Date Paid: ~ount: [Page 1 of 2] 2-15-84 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata ~-O~)~ Date .Installed Width of Field Depth of Field_ /~/~ of Syst,m Design Square Feet of Absorption Area Depression over Field (Y~ Results of last Adequacy Test ~QS~)'- ~ ~-~ Separation Distance f~om Absorption Field: To ~l~ter-Supply Wall //2~/ ~- To P~o~erty Line ;~-~-~3 To Building Foundation !J~! ~- To Existing or' Abandoned System cn Lot Al )~-- ; on Adjoining Lots ,_ ~- ~ TO Water Main/Service Line //.2/~-- To Cutbark( if present) To Stream/Pond/take/or Majo= D~aina~e Course ,~-/~ ~ Gravel Bed Thickness Standpipes P~esent ~N) Date of last Adequacy Test ~v~/~--/~ To D~iveway, Parking Area, or Vehicle Storage Area D. LIFT STATION Date Installed __ D' s Size in Gallons ______~~~ --~~~~t/~ .. ~-~ "Pu~mp on" Level Sat ~~P~mp~.O~vel High Water A1 Vent (Y/N) Cycles du~ing Adequacy Test. Meets MOA Tested fo~~ Electmical Codes~.~ Comments ** Check Permitted Bedrocm Rating A~ainst HAA Request I certify that I have checked, verified, o~ confomred to all MOA HAA C~ide,~'~s in effect on the dat this _ S ned ate MOA No. KB1/d5/s -- ' 2-15-84 ' ~ MUNICIPALITY OF ANCHORAGE DEPT. DEPARTMENT OP HEALTH & ENVIRONMENTAL PROTECT[O~JRON~v',~N]AL  825 L Street - Anchorage, Alaska 99501 ENVIRONMENTAL ENGINEERING DIVISION JU REQUEST FOR APPROVAL OF INDIVIDUAL WATER AND SE )IRECTIONS: Complete all parts on page 1. Incomplete requests will not he processed. Please allow ten (10) days for prucessing. PHONE 1. PROPERTY OWNER MAILING ADDRESS PROPERTY RESIDEN'r (If different from above) PHONE 2. BUYER PHONE MAILING ADDRESS '~. LENDING INSTITUTION PHONE MAILING ADDRESS 4. REALTOR/AGENT MAILING ADDRESS B, LEGAL DESCRIPTION " STREET LO~ATION ' 6, TYPE OF ~ESID'ENCE NUMBER OF BEDROOMS [] Other [] One [] Four /~ [] Two [] Five SINGLE FAMILY [] MULTIPLE FAMILY ,/E~__ Three [] Six WATER SUPPLY  INDIVIDUAL* * ATTACH WELL LOG, A well log is required for ell wells drilled COMMUNITY since June 1975. For wells drilled prior to that date, give well [] PUBLIC UTI LITY depth (attach log if available.) /'5z.43 ' ~ SEWAGE DISPOSAL SYSTEM /[~ INDIVIDUAL/ON-SITE** **If individual/on-site,~Jive installation date /2//??/ If system is over two (2) veers old an adequacy tes~ is required [] PUBLIC UTI LITY by this Department, .~ NOTE: THF 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 I NSP ECTOR INSPECTOR DIRECTIONS: 1. TYPE OF RESIDENCE NUMBER OF BEDROOMS [] SINGLE FAMILY [] ONE [] THREE [] FIVE [] OTHER [] MULTIPLE FAMILY [] TWO [] FOUR [] SIX 2. WATER SUPPLY PERMIT NUMBER [] INDIVIDUAL DEPTH OF WELL [] COMMUNITY DATE DRILLED [] PUBLIC UTI LITY Connection Verified LOG RECEIVED 3. SEWAGE DISPOSAL SYSTEM PERMIT NUMBER [] INDIVIDUAL/ON -SITE DATE INSTALLED E~PUBLIC UTILITY Connection Verified INSTALLER [~Septic or E~Holding Tank Tank Size: 1 ~LJ~) If Tank is homemade SOILS RATING ' give dimensions: TYPE OF TANK MANUFACTURER TOTAL ABSORPTION AREA MATERIAL '-7 4. DISTANCES Septic/Holding Tank Absorption Area Sewer Line ~ Nearest Lot Line WELLTO: Absorption Area to nearest Lot Line 5. COMMENTS APPROVED FOR ~',~ BEDROOMS [~ONDITIONAL APPROVAL (letter must accompany certificate) [] DISAPPROVED DATE BY JTitle) / LEGAL DESCRIPTIOI~I ' 72-010 (Rev. 3/78) Bruce H. Boyd BRA Box 4007 Anchorage, Ak. (907) 345-~803 99516 SEPTIC LOG NE1/4 NWl/4 SW1/4 NE1/4 Sec 14 T11N R3W BM The septic tank is 120 feet from the house. There is 4 inch cast iron soil pipe running from the house to the septic tank. There is a clean-out prior to a 90 degree turn, which is 3 feet before the pipe enters the Greet 1000 gal. septic tank. There is a 20 foot section of 4 inch pipe between the septic tank and the Greer 9 foot steel crib. The excavation for the crib (10' X 25~ was dug to a depth of 18 feet. It was then backfilled with some gravel and the crib was set. More gravel was added to a level of 3 feet above the bottom of the crib. At that point a leach line was installed. Gravel backfill was added to 6 feet and a second leach line was installed. Gravel backfill was then added to the top of the crib. The top of the crib and the top of the septic tank were not covered until 1979 when the system was inspected. I, Bruce H. Boyd, did the work on the septic system on the above property myself, except for digging the pits and trenches. The excavation was done by Gorder Excavating. This system was put in according to GAAB specifications in the fall of 1974. The system was inspected in June, 1979 by the Municipality of Anchorage prior to our financing our home and property. However, although we have a permit, and a receipt for the inspection no record can be found by the Municipality. I, Bruce H. Boyd, swear that the septic system was put in according to GAAD specifications, and was approved by the Municipality as being according to specifications n 1979. I agree to accept all liability should this system be found not meet 1979 code, and will hold the Municipality of Anchorage blameless in such an event. to Bruce H. Notary - State of Alaska My commission expires ~-/~-~ . Bruce H. Boyd SRA Box 4007 Anchorage, Al(. (907) 346-1803 99516 WELL LOG NE1/4 NWl/4 SW1/4 NE1/4 Sec 14 T11N R3W SM I, Bruce ti. Boyd was present during the entire well procedure on the above property. FEET SOIL COMPOSITION 0-13 Mixed Boils 13-120 Bedrock drilling The first water was found at 70 ft. Flow rate increased through 90 ft. At 90 ft. the rate was 20 gal. per minute. No increase in flow was attained through 120 ft. Thus the final flew rate of the well is 20 gal. per minute. The well casing has been driven down to 60 ft. I, Bruce Iff. Boyd, swear that the above og is true and complete to tile best of my knowledge. Signed __¢~:~_~?.~ Date ~ Bruce H Boyd~-~ _.Bigned; and swo~,.,~ before% me this Notary Btate of Alaska COl ,,3! ~E7.57 ~,:~-' : : :: ~ l! ~of~,'"' ~' '' ,d':,'.'h /.¢~' U,} ., : '. : ', ~ ~., ,/ - ~/ ~-,. , ....... ~..~ THOSE SHOWN ON THE RECORDED pLAT ARE NOT SHOWN HEREON, . AS-BUILT NO CORNERS SET THiS DATE ! hereby eertL[y that ! have pe~ormed a Morlagee's in- spection of Ihe lol]owing descmbed pIcperty:.ff~,/, ~. Id, . ~Vchora~i ~c~r~ing P, ecmct, Alaska, and that lhe improve- a~ents situated thru'eon are wflhin the property l~nes and do not overlap or e]m;'oaeh on the property lying adjacent there- encroach on the premises in question and that there are no said ?operty except as indicMed hereon. Dated at Anchora[e, Alaska FRED WALATKA & ASSOCIATES Engineers and ,.qu'vex'ors PEI~.tlT and CERTIFICATE OF APPROPRIATION OF WATER Ceriifica~e No ...... 187 ..... ~ttlllll ~[! ~£11 ~1~ ~I!~PItP ~Irl~ltPlllft that the State of Alaska, pursuant to A.S. 46.15, as amended and the rules and regulations promulgated thereunder, hereby grants to Harcia l,. Poyd Star RoUte :A~ BOx 4/007, Anchorag~',"~'la~k~"!,;~9507 the right to the use of ............. 5.~P...gR~!...~...~.t.~...~-.q~'.~..~.. Per from the public waters of the State of Alaska for the purposes of. domestkc;,'t arden irri *ation The location of the water sou: ~d shall appertain is and the right to said follows: of real property described as